- What should I, as a person affected, bear in mind when taking medication for back pain?
- Over-the-counter painkillers for back pain
- Painkillers from the group of so-called NSAIDs: relatively well tested for back pain
- Acetaminophen: Very controversial due to its weak effects and side effects
- Prescription alternatives: COX-2 inhibitor or metamizole
- Externally applicable painkillers: creams and ointments
- Do herbal painkillers help against back pain?
- Opioids: Highly effective alternatives when other drugs do not help
- Other painkillers are usually only recommended in special cases
- Start exercising to avoid painkillers!
Whether in pill form, as a drop or locally applied as a cream: painkillers are part of the treatment for back pain for many people.
There are many different approaches: Some people treat themselves with medication available without prescription from the pharmacy for short-term (acute) symptoms, others receive strong painkillers prescribed by doctors as part of a therapy of severe permanent complaints.
This is why the scientific findings on painkillers in the treatment of back pain cannot easily be lumped together – there are simply many different painkillers and back pain is different from case to case.
Nevertheless, we would like to give you a brief overview of some of the painkillers frequently used for back pain.
What should I, as a person affected, bear in mind when taking medication for back pain?
The treatment of back pain with medications is of course easy – and many medications are also available without prescription. However, medication therapy should not be taken lightly in case of pain.
Of course, every medication intake, especially those that last longer, should be accompanied by a doctor and some principles of the current guidelines should be observed. 1
Starting with the selection of the medication, which should be tailored to your personal medical history, concomitant diseases and allergies.
In particular, if other medications are already being taken, the careful adjustment for interactions with the other medicines is to be considered. 2
You should be aware that drugs are at best supportive, but cannot cure back pain as a standalone therapy. 3
Therefore, a drug therapy should be started with realistic goals and expectations and the medication should be taken in the smallest dosage for as short a time as possible.
Ideally, medication intake is regularly checked for efficacy and side effects – and if it is no longer necessary, it should be stopped.
Over-the-counter painkillers for back pain
In most countries, some painkillers are available in pharmacies without a prescription. However, this should not hide the fact that these drugs also have serious side effects and interactions with other drugs.
Therefore, even over-the-counter medicines should not be taken lightly and should be consumed as short as possible. Ideally, the intake should be accompanied by a doctor or pharmacist.
Painkillers from the group of so-called NSAIDs: relatively well tested for back pain
They all have a similar pain-relieving and anti-inflammatory effect. 4
In the case of back pain, in fact, they often relieve pain and improve mobility, at least in the short term, and are therefore often the drugs of choice if there are no medical reasons for not taking them. 5
However, because of their sometimes worrying side effects in the gastrointestinal tract or kidneys, they should only be taken as briefly as necessary – and the intake of these drugs should be accompanied by a doctor. 6
If necessary, protective measures can also be taken against some of the side effects, such as the simultaneous use of drugs that suppress the production of gastric acid. These drugs can reduce the side effects in the gastrointestinal tract. 7
Acetaminophen: Very controversial due to its weak effects and side effects
Traditionally, acetaminophen also plays a certain role in pain therapy for back pain, especially since it is a well known drug that is available without a prescription.
However, new studies indicate that acetaminophen is no better for acute back pain than a placebo treatment and that there is no clear evidence that the drug actually relieves the pain, even with prolonged back pain. 8
The traditional claim that acetaminophen has few side effects is also becoming increasingly controversial from a scientific point of view. 9
Therefore, new guidelines no longer recommend treating back pain with acetaminophen. 1
Prescription alternatives: COX-2 inhibitor or metamizole
If better-tested drugs for low back pain are not effective or are not tolerated, these drugs are alternatives according to current guidelines. 2
So-called COX-2 inhibitors also alleviate back pain in studies, but are not approved in Germany for the treatment of back pain. It is precisely because of their side effects on the cardiovascular system that they should only be prescribed to selected patients by doctors. This applies in particular to diseases that are outside the actual approval range (so-called “off-label use”) – such as low back pain. 2
The same applies to metamizole, a comparatively highly effective painkiller. It is approved for severe pain, but due to its rare but threatening side effects with inhibition of the formation of important white blood cells, it should only be used cautiously – e.g. if other drugs do not work sufficiently or are not available. 1
Externally applicable painkillers: creams and ointments
Externally applicable drugs such as creams are popular with many people affected.
Creams containing capsaicin, the active ingredient of cayenne pepper, are popular, for example. They are intended to stimulate blood circulation at the site of application and thus have an analgesic effect. The same active ingredient is also used in the form of a patch for pain caused by nerve irritation. 10
In fact, initial studies show that creams containing capsaicin can really help against back pain. 1
Pain-relieving and decongestant effects are also said to be caused by ointments from comfrey. However, according to the guidelines, reliable proof of efficacy is still lacking. 1
There is no reliable proof of efficacy for creams with medicinal agents from the NSAIDs group, such as diclofenac gels – however, some pronounced side effects are known, which is why creams with NSAIDs should not be used as active agents for back pain. 1, 11, 12
Do herbal painkillers help against back pain?
Herbal medicines are very popular with many people. Two herbal preparations are indeed already mentioned in the current guidelines.
Medicines based on willow bark contain several active ingredients, some of which are similar to the active ingredient of aspirin.
According to the guidelines, willow bark is indeed an option in the context of an overall treatment concept, especially too short-term treatment for back pain, and has already been scientifically investigated. 13, 14
Although it is a herbal preparation, the side effects and contraindications should be considered – they are quite similar to those of aspirin.
Preparations based on the rampion are also comparatively well researched herbal pain medications. However, they are not approved for low back pain and are therefore not recommended according to the guidelines. 1
Both preparations are currently not reimbursed by statutory health insurance funds in Germany.
Opioids: Highly effective alternatives when other drugs do not help
If other painkillers do not help sufficiently, so-called opioids can also be used in accordance with the guidelines. 2 However, these comparatively strong drugs are also considered to have side effects and should therefore be reserved for cases in which other drugs are not sufficiently effective or cannot be used.
There are indications that opioids can improve back pain, but this is particularly true for chronic back pain that has existed for some time. With shorter lasting complaints little is known about the effect of these painkillers. 15
Because of the side effect and the addiction potential, opioids should only be taken for as short a time as necessary – and if they do not bring an adequate improvement within a few weeks, they should be discontinued. 16
Opiate painkillers are also available in the form of patches. Although these patches release the active ingredient slowly and thus achieve a continuous effect, they can also last longer than desired. Therefore, they should only be used for chronic back pain, if at all. 1
Because opioids cannot heal back pain either, but is only a support, it should always be part of an interdisciplinary therapy concept, especially when pain persists for a long time. 16
Other painkillers are usually only recommended in special cases
Only in rare cases are other medications necessary and recommended for the treatment of back pain. 2
In principle, there are other drugs that can support painkillers, but are not painkillers in the true sense: so-called co-analgesics. However, these drugs generally have little evidence of efficacy in the treatment of back pain. 1
For example, drugs that are actually used to treat depression are sometimes also used in pain therapy. These so-called antidepressants do not seem to have a clear effect on back pain studies. Therefore, they should only be prescribed if, in addition to back pain, there is also depression or a pronounced sleep disorder. 1, 17
Medicines that were originally developed for the treatment of seizures, so-called antiepileptic drugs, are also used to treat pain. In the case of pure back pain without radiance, there is little convincing evidence for its effectiveness. At best, in the case of pain that experts believe is caused by nerve irritation, there are indications of its effectiveness and therapy can be tried in individual cases. 1, 18
The current guidelines also take a critical view of drugs that primarily work by relaxing muscles. While they may at best provide a brief pain relief in acute pain, this effect is countered by relatively pronounced side effects. Therefore, current guidelines generally recommend not to use these drugs for therapy. 1,18
Start exercising to avoid painkillers!
In order to avoid painkillers you can be proactive and start with the multimodale pain therapy by using the Kaia-Health App. With less than 15 minutes of Kaia exercising a day, you strengthen and stabilize your back in the long run and you will be on the best path to a pain-free life. It contains 150 back exercises, which were created in cooperation with the pain specialists of a large pain centre and uses them to create an individual training plan.