Which drugs are best for lower back pain / sciatica?

Your question assumes that there is a standard answer, and that everyone’s lower back pain / sciatica responds in the same way to specific medications.  That is definitely not the case for a variety of reasons.  A better question for you to ask would be..

How do I know which (combination of) drugs are going to relieve my lower back pain / sciatica optimally, when should I take them, and for how long?

Important note: You should seek medical advice if you are contemplating using medication to alleviate your lower back pain or sciatica.  Especially if you are taking any other medication for any other illness – prescribed by a doctor or not.  The information provided below is offered as background information – not as medical advice.  I am not licensed to prescribe you medication.

Drugs/pills/medication – helpful, but not a cure

The clinical guidelines (and the research behind them) recommend the use of certain medications to help with LBP and sciatica.

Don’t expect medication to solve your problem. In acute pain (less than 6 weeks), it can numb the symptoms while your body heals, and decrease the risk of developing chronic pain (more than 12 weeks). In chronic pain, it can help you to manage your pain while taking other steps to resolve the underlying causes.

When should I take drugs for lower back pain / sciatica?

  • For the relief of acute pain, helping you to avoid the development of chronic pain.
  • For the relief of chronic pain, which can facilitate a long-term improvement in combination with other strategies.

The Analgesic Ladder

The analgesic ladder is a useful model to discuss the management of pain.  In principle, the guidelines recommend starting at the bottom of the ladder, and if those medicines are not helping, moving up to the next rung.

First Rung:

Non-opioid (e.g. paracetamol/acetaminophen) and non-steroidal anti-inflammatories (NSAI) e.g. ibuprofen.  Take paracetamol initially and if this provides little relief, then add in anti-inflammatories with mealtimes.  Ideally take the paracetamol (which is faster acting) and then 2 hours later (with food) take the NSAI.   Cox-2 inhibitors are an alternative type of NSAI’s (e.g. celecoxib) – do not take both.  Do not exceed the recommended dosages.

Second Rung:

Weak opioid (e.g. codeine phosphate, dihydrocodeine, tramadol) can be added to the non-opioid regime.

Third Rung:

Strong opioid (e.g. Morphine, diamorphine, oxycodone) can be added to the non-opioid regime; stop weak opioids.

Strong opioid medications should only be prescribed if…

  • You’ve had pain for more than 2 years, AND
  • Failed all other pharmacological / interventional management, AND
  • No history of substance abuse, AND
  • You take medication as prescribed and you agree to see your doctor regularly, AND
  • You understand that the medication is there to help you do more rather than to “cure” your problem.

Other Useful Medications:

Tricyclic antidepressants (e.g. amitriptyline) have been recommended for the treatment of pain (particularly chronic pain and pain due to “nerve compression”).  These are taken in smaller doses than would be prescribed for depression and are very effective in many cases of nerve pain.  If you have sciatic pain which is driving you up the wall, making it difficult (or impossible) to sleep, it’s well-worth asking your doctor whether amitriptyline might help to control your pain in order to allow you to sleep.

Gabapentin and Pregabalin are often effective in the management of pain (particularly pain due to “nerve compression”).  They are not on the UK National Institute of Health and Care Excellence’s list of recommended medicines for low back pain (although widely prescribed by doctors), but they are recommended by the American Chronic Pain Association for “neuropathic pain” (which would include nerve compression) and are widely used with benefit in people with these severe pains.

It is very important to note that medication should be viewed as a potentially valuable part of the process of getting better; but do not expect it to “fix” your pain.  It can be a very useful part of your over all strategy – particularly in resolving long-term (chronic) pain.

Summary

  • Check with your doctor/pharmacist first.
  • If you develop new symptoms they could be side-effects (e.g. sore stomach, nausea), so stop taking the drug and consult your doctor.
  • Start with paracetamol.
  • Combine with ibuprofen if necessary (take at different times).
  • Go to your doctor for stronger medications.
  • Sensible to keep your pain under control while you follow other strategies to resolve the underlying causes.
  • Helps to avoid the development of “chronic pain syndrome”, but be careful you don’t become addicted to the medication itself.

Putting it into Practice – Which drugs and when?

The below regimes are examples and you should not take them as recommendations for yourself.  Consult a doctor or phramacist about medication.  You should read the information leaflet that comes with the medication, and report any new symptoms to your doctor.

First step

1g of paracetamol up to 4 times in 24 hours, usually start your day with it and then space out evenly after that.

Next step

400mg of ibuprofen with meals, three times in 24 hours; and 1g of paracetamol evenly spaced in between the ibuprofen (up to a maximum of 4g of paracetamol in 24 hours).

Next step

Go to see your doctor, and ask for exact guidance on when to take which drugs, or ask the pharmacist for guidance.

Feel free to get in touch if you’d like more than information on medication.  You can schedule an appointment on Skype or in person here.

By |2019-01-10T15:19:16+00:00January 9th, 2019|Everyday Tips, Treatments that Work|0 Comments

About the Author:

Clinic Director and Osteopath. Gavin graduated as a Gold Medallist in 1991 and is now a Vice Patron of the British School of Osteopathy. Co-author of “The Back Book” with Gavin Hastings OBE in 1996, and author of "active X backs - an effective solution for lower back pain"; he has an MSc in The Clinical Management of Pain from the University of Edinburgh. He's passionate about helping to move people as far from illness and pain as possible, and in January 2015 set himself the target of helping a million people get a better back.

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