Medications can play a useful role in patients with spine pain when used in conjunction with rehabilitation, spinal injections, and/or surgery. The most useful classes of medications are anti-inflammatories, opioids (previously called narcotics), anticonvulsants, antidepressants, corticosteroids, and muscle relaxants. Examples of anti-inflammatories include over the counter drugs such as ibuprofen and naproxen or prescription drugs such as etodolac, diclofenac, and celecoxib, among many others. Opiods include hydrocodone (in Vicodin® and Norco®), oxycodone (Percocet®), and morphine, among many others. The choice of the class of medication and the specific drug within each class depends on the cause of the pain, its severity, and how long it’s been present, coupled with the individual needs of each patient.
For a patient with acute pain, the goal is to use the medications is to minimize pain and maximize function. The medications used most often for acute pain are anti-inflammatories, opioids, and muscle relaxants. Muscle relaxants lose their effectiveness in most patients in about ten days, so are rarely used for longer periods. The choice of opioid would depend on the severity of pain.
For patients with chronic spine pain, other types of medications are used, often in addition to anti-inflammatories. Often, anticonvulsants are used if there is a predominance of arm or leg pain. Examples include gabapentin (Neurontin®), pregabalin (Lyrica®), and topiramate (Topamax®). Anti-depressants can also be helpful when there is a predominance of arm or leg pain. Examples include nortriptyline and duloxetine (Cymbalta®). When pain is not controlled with these medications, opioids are often appropriate. In chronic pain, continuous release or long-acting opioids usually give better pain control. Examples include extended release morphine, oxymorphone (Opana®), oxycodone (Oxycontin®), and methadone, again among many others.
The spine specialist and pain medicine specialists now have a large number of medications to help patients with pain. However, medications alone are never a cure for spine pain. Patients must take the responsibility to exercise, optimize their activity levels, and manage their weight. In addition, and perhaps most difficult of all, is to realize that although their pain is bad, they are not doing more harm by being active.