When using prescription medication, we advise you inform yourself as much as possible. Different drugs have different purposes. Some are dedicated to reducing pain, whilst others reduce inflammation; some even combine these two aspects. There are various prescription drugs which are just higher strength versions of other over-the-counter (OTC) medication. You shouldn’t mix OTC meds with prescriptions unless your doctor recommends it. Take a similar line when it comes to supplements. When you see your doctor inform them of everything you’re taking. Some drugs and supplements may be suitable to take simultaneously, whilst others can cause reactions.
Just like all drugs, take note of whether you should take your prescription medication with or without food, or if you should avoid particular foods. If you are unsure you should talk to your pharmacist. Some medications, particularly pain medicines, should not be taken while driving or operating heavy machinery. It is actually against the law to drive whilst under the influence of some prescription medications, so definitely read the instructions.
There are usually just three different medications which are prescribed for back problems: pain medications, anti-inflammatory drugs, and muscle relaxants. Sometimes neuropathic pain medications are also prescribed; the same is true for antidepressants and anticonvulsants.
The World Health Organization outlined a method of controlling pain; this is called the pain ladder. The gist of it is to begin treatment at the bottom using over-the-counter medications and go further up the ladder if the pain continues. If you’ve received a prescription for pain medications from a doctor, it usually means you’ve tried over-the-counter drugs including aspirin or acetaminophen and they haven’t done the job.
The most powerful drugs in this group are opioids (opiates). Opioids are a selection of drugs which includes morphine and codeine. They work extremely well to reduce pain but do have the potential for of addiction. The more potent they are, the higher the potential. Nevertheless, they do have a place, but usually for extended periods of time.
Morphine, codeine, opium, and heroin are different opioids; they are all derived from the opium poppy. The human body releases endorphins as a natural pain killer. Opioids stimulate endorphin receptors. They essentially mimic these endorphins.
Tolerance is the basically an accumulation of resistance to opioids. Essentially, your body’s metabolism breaks down the current dosage faster, meaning that you need a higher dose to get the same effect. This is not the same as addiction, but it is related. Patients form a tolerance when the current dosage no provides pain relief, so they need more. Addiction happens when there are adaptive alterations to the brain resulting in an uncontrollable craving for a substance.
You’ll likely receive a prescription for codeine or a semisynthetic relative (oxycodone or hydrocodone). The brand-names below are combined with other drugs. The combination helps lower the quantity of opioids required. These are commonly prescribed for back pain:
- Tylenol 3(codeine with acetaminophen)
- Vicodin(hydrocodone with acetaminophen)
- Percodan (oxycodone with aspirin)
- Percocet(oxycodone with acetaminophen)
There are also fiercer pain medications, usually prescribed after surgery, a severe injury, or for particularly stubborn pain:
- Fentanyl patch (synthetic drug many times more potent than morphine)
- OxyContin(long-acting oxycodone)
Common side effects of opioids include sleepiness, lightheadedness, and constipation.
If your pain grows to the point that you require surgery, it’s better to be on a little drugs as possible prior to the operation. If you have developed a tolerance, the pain from surgery may be very hard to control.
The most common anti-inflammatory which are prescribed are nonsteroidal anti-inflammatory drugs (NSAIDs). They work in a very similar way to the over-the-counter form by lowering prostaglandin production (chemicals involved in many functions such as promoting inflammation and protecting stomach lining). These drugs do, however, have side effects; an upset stomach is the most common. Your prescription is probably a higher dosage of what is available over-the-counter.
There is a relatively new class of NSAIDs known as COX-2 inhibitors; they have the benefit of reducing inflammation, but without causing the stomach issues. Two of these drugs (Vioxx and Bextra) were removed from the market due to a link with an increased risk of heart attack and stroke when used over long periods of time. The only COX-2 inhibitor currently available in the United States has the brand name Celebrex.
As a general rule of thumb, NSAIDs work quickly, often within a half-hour or so. They are prescribed for a variety of back conditions, such as arthritis and strain/sprain injuries.
Steroids are very potent anti-inflammatory drugs. They are prescribed for back pain but the majority of doctors prefer NSAIDs to prevent the side effects of steroids. Long-term use of steroids can result in to weight gain, stomach ulcers, osteoporosis, and various other problems. They can also raise blood sugar in diabetic patients. If steroids are prescribed, they are usually intended for short-term use—for instance, one to two weeks.
If muscle spasms are causing severe pain, your doctor could prescribe a muscle relaxer. They are a class of drug with various different chemical makeups. As they have no effect on inflammation, they can be prescribed in conjunction with an anti-inflammatory drug.
Muscle relaxants don’t directly affect your muscles; they affect your brain and spinal cord by lowering motor activity, this in turn reduces muscle spasm. In reality they, they relax the whole body. A reduction in muscle spasm can be beneficial before doing therapeutic exercises as it allows you to achieve a larger range of motion. Unfortunately, these drugs can also make you sleepy. Commonly prescribed muscle relaxants include:
- Soma, often taken on a short-term basis due to its habit-forming ability
- Valium, another short-term drug with the potential to affect sleep cycles
- Flexeril, which can be prescribed for longer periods of time
Neuropathic Pain Agents
Lastly, some people who suffer from chronic pain can actually be prescribed antidepressants or anticonvulsants. Antidepressants are given to calm down the nervous system and increase the amount of chemicals which reduce pain signals. Anticonvulsants also affect nerve communication, muffling the nervous system and hence reducing pain. All of these drugs relieve neuropathic pain and can also be prescribed for other conditions.
Neuropathic pain is nerve-based pain shown by trauma, irritation, or chronic changes in nerves. This differs to nociceptive pain, as nociceptive pain is the result of damage to other tissues in the body, which is transmitted by nerves. Neuropathic agents are more useful against nerve-related pain.
It’s not unusual for pharmaceutical drugs to have more than one condition that it is used to treat. Drug companies usually promote the drug for the use which will reach the largest group of patients. For instance, the drug with the brand name Lyrica (pregabalin) is usually prescribed for people with neuropathic pain caused by diabetes; the drug with the brand name Neurontin (gabapentin) was first developed for epileptic seizures. Both these drugs work through affecting the central nervous system. Because of this, they can be prescribed for other conditions, including back pain as a result of nerve damage.