Low back pain and painkillers – top tips.

Low back pain and painkillers is a big subject, so here’s how I’m going to break it down.  First we’ll define what painkillers are and what they’re not.  Then we’ll cover a few guidelines in principle.  Then I’ll give you my take on “should I take them or not?”.  DO NOT TAKE THIS AS MEDICAL ADVICE – ALWAYS CONSULT YOUR DOCTOR OR HEALTHCARE PRACTITIONER. (Sorry, I have to put that disclaimer in).

What are painkillers?

Also known as analgesics, this is a particular kind of medication.  You could include non-medical painkillers like alcohol, but that opens too many cans of worms!  Let’s stick to over the counter (OTC) and prescription painkillers.  Bear in mind if you’re reading this and you’re not a UK citizen, your own country may have quite a different approach.  Many countries are more lenient about what you can buy OTC when compared with the UK.

What’s the difference between painkillers and anti-inflammatories like ibuprofen?

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID).  NSAIDs are designed to reduce inflammation, rather than to work directly on the pain-sensory parts of the nervous system.  There are quite a few NSAIDs.  In the UK the most commonly used ones are:

  • Ibuprofen
  • Naproxen
  • Diclofenac
  • Celecoxib
  • Mefenamic acid
  • Indomethacin
  • High-dose aspirin (low dose is not normally considered a NSAID)

So, if you want to reduce inflammation, you would use a NSAID.  Many people use NSAIDs for low back pain and painkillers at the same time. Because they work on different pathways to achieve different things.

What about other drugs for low back pain?

Sometimes doctors will prescribe muscle relaxants which we can split into the benzodiazepines and the non-benzodiazepines.  You can take them by mouth or have them injected (which is usually faster-acting).   They do help a lot of people in the short-term.  However, they come with a high risk of side-effects such as drowsiness and dizziness.  They are definitely only recommended for very short-term usa – a few days at most.

Your doctor might prescribe anti-depressants to help with pain.  But these are more commonly prescribed for people with sciatica with nerve involvement rather than for lower back pain.   Again, they come with quite a high risk of side-effects.

Low back pain and painkillers – how do they work?

The most widely used and easiest to get hold of painkiller is probably paracetamol (acetaminophen).  Amazingly, although it’s been in use for many decades we’re still not certain how it produces an analgesic effect.  The most-widely accepted theory is that it reduces something called prostaglandins in the brain.

The next one up the chain is arguably codeine which is an opioid drug. It affects 2 of 3 different types of “pain nerve” endings, reducing transmission and thereby reducing pain.  You can get hooked when taking codeine for low back pain. Co-codamaol is a mix of codeine phosphate and paracetamol.

Moving up through the opioids, we include oxycodone, hydrocodone, morphine and fentanyl.  These are pretty serious medicaitons with high-risks of dependence/addiction.  Generally opioids work by binding to one of 4 different opioid receptors in the spinal cord and brain.  They block your ability to experience painful inputs.  There is huge concern about the overuse of opioid medications in the field of low back pain and painkillers.  Nowhere more than in the USA.

What do I recommend?

As an osteopath in Edinburgh, I have always known that the biological purpose of pain is an alarm system.  It’s there to warn you not to do something. If you suppress the symptom without investigating its cause, you might say that’s a bit silly.  There is a role for painkillers and other medications. If you’re finding sleep very difficult, then painkillers can help you.  Night time is probably the best time to resort to pain relief. But what I often see is people using piankillers in order to keep doing things that are otherwise too painful to do.  This is definitely a bad idea.  Remember, pain is there to warn you not to do something.  If you take painkillers in order to keep doing otherwise painful things, you will aggravate the underlying problem.  It probably won’t get better.

So I recommend that you take painkillers if you need to in order to sleep.  And only at other times if you need to in order to survive.  And of course, on the recommendation of your doctor – I am not a doctor and I do not prescribe medication.

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