Potential Safety Risks of Pain Medication for Back and Neck Pain

While pain medications offer relief, it's crucial to acknowledge potential safety risks when managing back and neck pain. The side effects and adverse events of pain medications depend on the specific process through which the medication acts on the body. 

Common Side Effects of Pain Medications for Back and Neck Pain

Most pain medications with systemic (whole-body) effects are associated with mild side effects, including^-:

• Nausea
• Gastrointestinal upset
• Headache
• Dizziness

In rare cases, pain medications may cause severe allergic reactions in individuals with hypersensitivity.^,

Medications that act primarily on the central nervous system (eg, opioids, muscle relaxers, anticonvulsants, and antidepressants) also cause mild to moderate sedation.^-

Common side effects of topical pain medications

Topical pain medications are associated with little-to-no systemic side effects, but skin irritation and other cutaneous effects are possible, such as rash and itching.

Handwashing after applying topical medications, especially capsaicin, is important to avoid accidentally spreading the medication to unintended and/or highly sensitive areas, such as the eyes.

Serious Risks of Pain Medications for Back and Neck Pain

The most significant adverse events of pain medications involve organ injury due to the way these drugs are processed and eliminated. Organ issues typically include liver damage (elevated liver enzymes and cirrhosis) and kidney injury (acute kidney injury and chronic kidney disease).^,

Additional risks of specific pain medications include:

• Pain medications that act on the central nervous system (CNS) may cause CNS depression (profound sedation, cognitive impairment, or respiratory depression).^-   
• Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal ulcers and bleeding, and the risk is increased with higher doses and long-term use.
• Systemic corticosteroids may lead to significant immunosuppression when used for long periods, which increases the risk for serious bacterial, viral, and fungal infections.
• Epidural injections and intrathecal injections are associated with risks for serious neurologic complications (eg, stroke or spinal cord injury) and infection due to the potential risk of improper administration.

This is not a comprehensive list of potential adverse events of pain medications. Patients are encouraged to talk to a medical professional if they have concerns about the risks of a specific drug.

Potential Risks of Opioid Addiction

It has been well-established that opioids are associated with significant risks of abuse, misuse, and addiction due to their central nervous system depressant effects and rapid development of tolerance (the need for higher doses over time to have the original effect).^,

The risk of opioid addiction varies from person to person, and it is important to note that an individual does not have to abuse or misuse the medication to become addicted.^,

Tolerance to opioids occurs even when the drug is used as directed, and the risk of addiction increases when opioids are used for long periods.^,

See Opioid Medication Potential Risks and Complications

Using Pain Medications in Older Adults

The use of many pain medications, including some OTC medications, in older adults is associated with increased risks of side effects and adverse events due to age-related factors:

• The normal function of organs (eg, kidneys, liver, and lungs) naturally declines with age, and older adults are more susceptible to the damaging or suppressive effects of certain pain medications on these organs.
• The ability of the body to process and eliminate medications diminishes with age, leading to exaggerated side effects from medications, especially cognitive side effects, and elevating the risk of other complications and injuries.
• Older adults are more likely to have underlying medical conditions and take multiple medications that can impact the safe use of pain medications.

Pain medications such as opioids, muscle relaxers, and systemic corticosteroids are generally considered unsafe for older adults due to these age-related risks.

Using Pain Medications in Pregnancy and Lactation

Some pain medications (eg, NSAIDs and opioids) have been studied extensively, and specific guidance for use during pregnancy or lactation is available. However, other medications have limited safety information, and it is advisable to consult with a doctor before using pain medication in this population.

Use of NSAIDs during pregnancy 

NSAIDs are associated with severe risks to the developing fetus (such as kidney damage, low amniotic fluid, and heart abnormalities) when used at certain stages of pregnancy.^,

Generally, NSAIDs are safe to use during the first 20 weeks of pregnancy (first trimester), but they should be avoided during the second and third trimesters.^,

Use of opioids during pregnancy 

The use of high-dose opioids, or long-term use of opioids at any dose, has been associated with neonatal opioid withdrawal syndrome or severe respiratory depression in newborns.^, In cases where opioids are used during pregnancy, it is strongly advisable to ensure the proper treatment is available at the time of birth to manage potential withdrawal symptoms quickly.

Use of opioids in women who are breastfeeding

Some opioids can pass into breast milk and present a significant risk of sedation and respiratory depression in breastfed infants. Additionally, infants exposed to opioids through breast milk may experience withdrawal symptoms when the mother stops taking the medication.^,

Safe Use of Pain Medications for Back and Neck Pain

While all side effects and risks are not preventable, the safe handling of pain medications reduces the chances of accidental overdose and related complications.

Following dose instructions

The potential side effects and risks of pain medications are primarily dose-dependent, and taking doses higher than prescribed or recommended significantly increases the risk of complications.^,,,

Following dose instructions is equally important for OTC pain medications (eg, NSAIDs and acetaminophen) which have daily dose limits due to the potential for severe liver or kidney damage at higher doses.^,

Avoiding manipulation (crushing, splitting, or cutting) of medication

Some pain medications are specially formulated to provide long-lasting effects by releasing small amounts of the drug over time (eg, delayed-release pills, extended-release pills, and transdermal patches). If these medications are crushed, cut, or split, it can cause too much of the drug to be released at once and increase the risk of severe side effects or adverse events.^,

Limiting the use of alcohol 

Concomitant use of alcohol with many pain medications can increase the risk of sedating side effects. This is particularly dangerous for people taking opioids and muscle relaxers.^,

Alcohol use also heightens the risk of liver damage when combined with certain drugs, including acetaminophen and NSAIDs.^,

Additional factors influence the effectiveness and safe use of the drugs used in the treatment of back pain and neck pain, and it is important to discuss these and other concerns with a doctor.

Alternative Therapies for Treating Back and Neck Pain

While medications are practical tools for treating back and neck pain, alternative strategies are effective for managing chronic pain and preventing additional injury.

Correcting vitamin and mineral deficiencies may help back and neck pain

Several vitamins and minerals contribute to the overall health of bones, nerves, muscles, and other tissues in the body, and correcting deficiencies of the following vitamins and minerals may help improve back and neck pain:

• Vitamin B12
• Vitamin C^,
• Vitamin D
• Vitamin K
• Calcium
• Iron
• Magnesium
• Zinc

Before taking vitamin or mineral supplements, consultation with a doctor and laboratory tests to identify the need for supplementation is advisable.

Natural supplements for back and neck pain

Natural supplements with anti-inflammatory, healing, and pain-relieving properties may provide modest relief from back and neck pain over time, including^,,:

• Turmeric
• Ginger
• Fish oil

Interactions between supplements and medications have the potential to cause serious side effects or reduced effectiveness, and it is important to speak with a qualified healthcare provider before use.

Considering non-drug therapies for back and neck pain

Alternative treatments that may help to alleviate back and neck pain include^,:

• Physical therapy
• Massage therapy
• Heat and cold therapy
• Yoga and stretching
• Acupuncture
• Cognitive behavioral therapy (CBT)
• Red light therapy (photobiomodulation)
• Transcutaneous electrical nerve stimulation (TENS)

Combining alternative therapies with pain medication optimizes pain management and function.

Preventing additional injury to avoid worsening back and neck pain

Lifestyle modifications that may help to prevent further damage or worsening of back and neck pain include:

• Engage in regular low-impact exercise and avoid prolonged periods of inactivity.
• Minimize high-impact and repetitive activities that strain back and neck muscles.
• Maintain proper posture and make ergonomic adjustments.
• Use footwear and shoe inserts that provide proper support.
• Invest in a mattress and pillow that adequately supports the back and neck.

Additionally, maintaining a healthy weight, consuming a well-balanced diet, and ensuring adequate hydration all contribute to promoting the body's natural processes of healing and maintenance.