Relieving Pain When Swallowing Pills Is Difficult

Oral medications are often the most effective and economical way to relieve back pain, yet many people have trouble or dislike swallowing pills. In addition, most pills (including tablets and gelcaps) are designed to be swallowed whole, and crushing or chewing them is not an option. This page discusses techniques that make swallowing pills easier as well as alternatives to oral medications, such as topical pain relievers.

See Medications for Back Pain and Neck Pain

Techniques for Swallowing Pills

Researchers have found that these two pill-swallowing techniques help most people:1

#1: The lean forward method

  • Place tablet or pill on tongue
  • Take a sip of water but do not swallow it
  • Lean the head slightly forward, bringing the chin a little down and toward the chest (this movement is relatively subtle, and the chin should not touch the chest)
  • In this position, swallow the pill

#2: The pop-bottle method

  • Fill a flexible plastic water or soda bottle with water
  • Place the pill or tablet on the tongue.
  • Wrap lips tightly around the bottle opening (so no air escapes)
  • Keep lips pursed, tilt head back and drink from the bottle with a sucking motion, swallowing pill right away.

Because no air is allowed in or out of the bottle, the bottle will collapse in on itself a bit. Researchers suggest that leaning the head back may increase the risk for breathing in water (aspiration) and advise patients to consult a physician or speech therapist before trying this method.

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Alternatives to Oral Medication for Back Pain

If oral pain medication is not a good option, patients and health care providers can discuss alternatives that might be appropriate.

See Specialty Care Physicians and Pain Management

Topical medications that are absorbed through the skin. Back pain relievers that can be applied to the skin include:

  • A non-steroidal anti-inflammatory gel (e.g. aspirin creme or Voltaren Gel)
  • 5% lidocaine transdermal patches or creme (e.g. Lidoderm patches)
  • Opioid transdermal patches (e.g. fentanyl or buprenorphine patches)

Injections. A doctor may inject a small amount of local anesthetic (numbing agent) and/or steroid medication to anesthetize the affected structures of the spine and block the pain. Spinal structures that often receive injections include facet joints, spinal nerves, the epidural space, and paraspinal muscles.

See Injections

Medications that can be sprinkled on soft foods. The FDA has approved a few types of oral capsules that can be broken open and the contents sprinkled on applesauce or other soft foods. Soft foods are required because the capsule’s contents—usually tiny pellets—must be swallowed without being chewed.

Integrative care. Using a combination of conventional Western medicine and alternative medicine, integrative care can decrease the reliance on oral medications by using treatments such as massage, acupuncture, anti-inflammatory diets, and exercise.

See Can Massage Help Your Back Problem? and Back Exercise for Pain Relief

Medical marijuana. This pain treatment has very limited clinical research to support its use. Medical marijuana is legal in certain states for limited number of conditions, such as rheumatoid arthritis and spinal cord injuries and diseases. (Approved conditions vary by state.)

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While not common, a few opioid medications are administered through the nose or rectum.

  • Nose sprays (intranasal). In some cases, opioid medications can be administered to the nasal passages, where it is absorbed.
  • Rectal suppositories. Most opioids that can be taken orally can also be made to take rectally, though this poses challenges. Dose uptake may be inconsistent, meaning absorption may occur too quickly or inadequately, depending on circumstances. For example, the person can pass the medication with stool before absorbing it.

More alternatives to oral pain medication are being developed as awareness increases of trouble swallowing and its impact on chronic pain management.


  1. Schiele JT, Schneider H, Quinzler R, Reich G, Haefeli WE. Two Techniques to Make Swallowing Pills Easier. Annals of Family Medicine. 2014;12(6):550-552. doi:10.1370/afm.1693.
Written by Thomas Cohn, MD