Topics in Medications

In this article, we will discuss the pharmaceutical medications that are used to treat back pain and other musculoskeletal disorders. Our topics in medications in this article will include the kinds that are available either over the counter or by doctor prescription. We will leave out other back pain treatments such as vitamins, nutritional supplements, and herbal medications, which will be discussed in other sections of this website.

In our first medication topic, we will ask these two questions:
  • Do any of these back pain medications actually work?
  • If so, which medications work the best?
In order to answer these questions, we will compare different categories of medications to one another in terms of their treatment efficacy, as well as their side effects.

Medications: Medications for pain may be specific to how severe it is as well as its cause. In some cases, alternative medications are considered and tried after the primary choices selected by doctors have failed to provide their desired benefits. That is the reason why some patients' ends up taking things like narcotic medications, which have some of the most serious side effects, including tolerance and addiction.

First Line of Defense: Anti-inflammatories are typically the first line of defense for back pain and arthritis pain because they often do work, and they have been determined to be relatively safe. One great thing about anti-inflammatories is that they treat two aspects of pain cases: pain and inflammation. These anti-inflammatories block pain signals from reaching the brain while they reduce inflammation at the site of the injury.

All three groups of anti-inflammatories are considered to be safe when used once or over short term periods. The safety of all three of these products goes down rapidly the longer they are used and the more they are used. Long-term use of these pharmaceuticals have associated complications as serious as Gastrointestinal bleeding, liver and kidney disease, and destruction of soft tissue/bone.

There are three main types of anti-inflammatory medications: non-steroidals, steroids, and immune selective anti-inflammatory Derivatives (ImSAIDS).

Non-steroidal anti-inflammatory drugs (NSAIDS): When we become injured, or when the soft tissue inside our bodies become inflamed or deteriorated, the body responds by releasing inflammatory enzymes from the injured tissues. These enzymes include the cyclooxygenase (COX) enzyme. The COX enzyme synthesizes prostaglandins, which is the next step in the inflammatory process. NSAIDS prevents the prostaglandins from being synthesized. By doing this, COX prevents pain and inflammation.

Common examples of NAIDS that work this way include naproxen, ibuprofen, and aspirin.

Most, but not all, anti-inflammatories provide the dual role of inhibiting inflammation and providing pain relief. Medications provide pain relief are also known as analgesics. Aspirin is one medication that is only designed act as an analgesic and does not also work as an anti-inflammatory. Aspirin is also known as acetaminophen and paracetamol. Acetaminophen is often an ingredient in narcotic medications such as hydrocodone (e.g. Vicodin is hydrocodone and acetaminophen). When acetaminophen is used in narcotics, it amplifies its pain-relieving effects.

Researchers and doctors now understand that the mechanism of action of acetaminophen is to block the reuptake of endocannabinoids.

Both aspirin traditional NSAIDS are believed to be harmful to the liver and kidneys when taken for long periods of time. For this reason, doctors may treat chronic pain patients with narcotic medications rather than risk these dangerous side effects. For severe of chronic pain, tramadol or opioids such as morphine, hydrocodone, or oxycodone may be prescribed by doctors. Doctors to not reach these decisions lightly, and they carefully weigh the risks against the benefits before making any decision.

Certain patient groups are at a higher risk than others for contracting medical problems related to long term NSAID use. Patients who are the most vulnerable include ones with cardiovascular and gastrointestinal, and those with diabetes.