July 25, 2008 · Print This Article
Medication Use for Sciatica and Back Pain
Medication, by far and away, is the most widely used conservative treatment for sciatica and back pain. Medications used to treat sciatica and back pain are prescribed individually or in combination with other types of medication with the goal of reducing pain and assisting people with maintaining function. And while some medication use is recommended for acute sciatica and back pain, the effectiveness of long term use to treat chronic pain has not been established. The purpose of this article is to provide an overview of the various classes of medication used to treat sciatica and back pain.
Opioids, also known as narcotics, are utilized for their analgesic or pain relieving properties. Opioids bind to the opioid receptors in the brain which, in turn, release endorphins to achieve pain relief. Most musculoskeletal pain responds to opioids as do some forms of headache pain. Common brand names of prescribed opioids include Darvacet, Vicodin, Lortab, Vicoprofen, Oxycodone, morphine, and Duragesic patches.
Side effects associated with the use of opioids depends on the person and also if the correct dosage was taken. The potential side effects of opioids are constipation, stomach upset, itching, and drowsiness.
One side effect of opioids that is monitored very closely is physical dependency. As the body becomes accustomed to the medication, the need for increasingly larger doses is necessary in order to achieve pain relief. For this reason, physicians try and wean low back pain patients off opioids within two weeks.
Non-Opioids (non-narcotic), Acetaminophen
Non-opioids include two types of medications: Acetaminophen (Tylenol) and non steroidal anti-inflammatory drugs (NSAIDs). These medications are used to decrease pain levels while increasing activity level.
The benefits are that it blocks the pain pathway to the brain. It works well for mild to moderate pain. They also work better with other medications to improve pain tolerance.
The side effects are minimal when taken as prescribed. Overuse of acetaminophen, however, has been linked to liver failure.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
The purpose of utilizing NSAIDs is to reduce the inflammatory effect. They may also decrease acute pain, swelling, and stiffness associated with common injuries and medical problems.
Most NSAIDs increase bleeding and should not be taken before a surgery. Upset stomach is the most common side effect and can be eased by taking the medication with food. Common NSAIDs on the market include Celebrex, Ibuprofen, Aleve, Advil, and Motrin.
Oral Steroidal Anti-inflammatory Medications
Oral steroidal medications are used to decrease inflammation. This type of medication is used to assist with mitigating acute flare-ups of pain. To decrease swelling and inflammation around the spinal nerves a short course of a steroidal anti-inflammatory can be quite helpful and usually means a quicker return to activity levels. The medication typically used for acute sciatica or nerve root pain is a Medrol dose pack.
Long term use of steroid medications has been linked to such problems as osteoporosis, diabetes, and poor wound healing. Side effects include mood changes, increased appetite, indigestion, increased nervousness, and decreased sleep.
Anti-Epileptic (Anticonvulsant) Medications
The anti-epileptic medicines help with coping with the heightened stress normally associated with long term pain. This is accomplished by stabilizing moods and managing neuropathic or nerve pain. Nerve pain is considered to be streaking, lightening, burning, tingling, pins and needles, or radiating pain. Common medications prescribed from this group of medications include Neurontin, Topamax, and Lyrica.
The side effects of anti-epileptic drugs include: drowsiness, dizziness, tiredness, swelling, upset stomach, tremor, blurred vision, dry mouth, constipation, anxiety, and weight gain. Abruptly stopping the use of this type of medication can cause the onset of seizures.
Anti-Depressants and Anti-Anxiety Medicines
Anti-depressant and anti-anxiety medicines are used to assist with decreasing pain and increasing overall mood. They also used to treat nerve pain by increasing the serotonin and norepinephrine activity. Commonly prescribed anti-depressants include Elavil, Cymbalta, and Effexor. Prozac, Paxil, and Zoloft are usually prescribed for their anti-depressant/anti-anxiety benefits rather than their pain relief benefits.
Upset stomach, feeling hyper, drowsiness, and tiredness are the most common side effects of anti-depressants and anti-anxiety medicines. They can also cause sexual dysfunction, flat mood, insomnia, headache, and appetite changes. Some can cause carbohydrate craving and weight gain.
Muscle Relaxants (Antispasmodics)
Muscle relaxants are commonly prescribed for patients with back pain and are used to decrease pain associated with muscle spasms. Muscle relaxants help keep muscle spasms under control, which is common following surgery, an injury, or increased activity. Commonly prescribed muscle relaxants include Robaxin, Skelaxin, and Flexoril.
The side effects of muscle relaxants are drowsiness, dizziness, lightheadedness, upset stomach, blurred vision, insomnia, low blood pressure and dry mouth. Physical dependence and addiction are common risks associated with some types of antispasmodics such as Valium and Ativan.
Sleeping Aids (Hypnotics)
Lack of sleep is a common complaint with patients suffering with sciatica and back pain. Sleep loss has been associated with poor healing and heightened anxiety. Sleeping aids will help a patient to sleep, which leads to one’s ability to cope with pain better. Commonly prescribed sleep aids include Ambien, Halcion, and Lunesta.
Sleeping aids cause daytime tiredness, nightmares, and dry mouth. Urinary retention, low blood pressure (which may result in falls), and confusion are risks for the elderly. Some medications may cause rebound insomnia when stopped and some sleep aids can also cause sleepwalking or amnesia.
Topical agents are utilized when a local analgesic effect is desired. These medications are combined with a cream or lotion and absorbed through the skin directly over the area that hurts, thus eliminating the need to be absorbed into the blood stream and the side effects of oral medications. Commonly prescribed medications that can be used topically include Voltaren, Zostrix, and Lidoderm.
The primary side effect of a topical agent is skin irritation. If applied too frequently, these medications can result in too much absorption, which will then cause the same side effects of oral medications.
Current medical research advocates the use of analgesics, muscle relaxants and NSAIDs at regular intervals for a fixed period of time to effectively treat acute sciatica and back pain. For chronic back pain sufferers, a short course of analgesics can be prescribed in order to facilitate a gradual increase in activities; however, long term drug use for chronic pain sufferers is discouraged.
In addition to drug therapy to treat both acute and chronic sciatica and back pain, exercise therapy has been shown to provide excellent results and is, therefore, highly recommended. The Erase Your Back Pain program utilizes a prescribed series of therapeutic spinal exercises that are designed specifically for your unique condition. Get all the details here: Treatment For Sciatica and Back Pain
Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment