There are multiple medications that can help relieve low back pain associated with degenerative disc disease. Any medication, including many non-prescription (over-the-counter) drugs, should be taken under a physician's care, direction, and supervision. Many of the pain medications below should not be taken by people with certain health conditions (e.g., diabetics should not use oral steroids since the medication increases blood sugar levels). Patients should ask their physicians and pharmacists about potential side effects of any medication.
- Acetaminophen (such as Tylenol) is a pain medication that works by dampening the brain's perception of pain. Unlike non-steroidal anti-inflammatory drugs, acetaminophen does not treat the inflammation that usually accompanies pain from a degenerated disc. In addition to its efficacy for addressing low back pain, acetaminophen is frequently recommended because it has relatively few side effects. Acetaminophen is available without a prescription and is generally considered to be one of the more effective pain relievers for treating painful flare-ups caused by degenerative disc disease.
- NSAIDs, or non-steroidal anti-inflammatorydrugs, are a class of pain medications that help reduce the inflammation in the low back that is associated with lumbar degenerative disc disease. NSAIDs comprise a large class of pain medications with many different options. In addition to aspirin, there are currently several types of both non-prescription (over-the-counter) NSAIDs and prescription brands of NSAIDs. The three types of NSAIDs most commonly used to treat low back pain from degenerative disc disease include:
- Ibuprofen (e.g. brand names such as Advil, Motrin, Nuprin)
- Naproxen (e.g. brand names such as Aleve, Naprosyn)
- COX-2 inhibitors (e.g. brand names such as Celebrex)
- Oral steroids, a non-narcotic type of prescription medication, are very powerful anti-inflammatory medications that are sometimes an effective treatment for low back pain from degenerative disc disease. Typically, oral steroids for low back pain from degenerative disc disease are prescribed in a Medrol Dose Pack, starting with a high dose to kick-start the impact of the medication and provide initial low back pain relief, then tapering down to a lower dose over five or six days. Because chronic steroid use leads to many possible complications, their use is limited to short period of time (one to two weeks) and is generally used only for flairs of severe pain.
- Muscle relaxants (such as Soma, Flexeril, and Valium) work by having an overall sedative effect on the body. Typically, muscle relaxants are prescribed early in a course of low back pain to alleviate pain caused by muscle spasms.
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- Narcotic pain medications are usually reserved for severe low back pain (on a short-term basis) and include codeine (e.g. Tylenol #3), hydrocodone (e.g. Vicodin), and oxycodone (e.g. Percocet, Oxycontin). Narcotics work by having a dissociative effect that helps patients manage pain. Narcotic pain medications are generally used only for severe episodes of low back pain as they can be addictive and patients become tolerant to their pain relieving affects quite quickly (over one or two weeks).
- Tramadol. This type of pain medication (e.g. brand name Ultram) is a non-narcotic pain medication that is stonger than Tylenol (acetaminophen) but not as strong as narcotic pain medications. It works centrally (in the brain) and does not have any anti-inflammatory effects. It can, however, be safely taken with anti-inflammatory pills or Tylenol. Ultracet is a brand name of a pain medication that includes both tramadol and acetaminophen, so patients taking Ultracet should avoid taking additional acetaminophen.
- Anti-seizure medications. These medications, such as Gabapentin (brand name Neurontin), are commonly used to prevent seizures and are now increasingly used to help control chronic low back pain. They can be especially useful in patients with nerve pain caused by the degenerated disc (such as sciatica or peripheral neuropathy). Patients can take anti-seizure medications for a long time as they are generally well tolerated.
Taking NSAIDs regularly in the appropriate dose lets the drug build up in the system in order to have an anti-inflammatory effect and provide a better healing environment for the low back. For recurrent episodes of low back pain and/or chronic pain, it is usually less effective to take NSAIDs only at the onset of pain. Sometimes doctors will recommend taking both NSAIDs and acetaminophen to address both the pain and underlying inflammation.
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