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Medicines and pain relief for lower back pain
Expert reviewer, Justin Hayde–West, Chief Pharmaceutical Officer’s Clinical Fellow at Bupa UK
Next review due December 2023
Your GP may recommend medicines to help ease your back pain. Pain relief can help ease the symptoms but these medicines won’t treat the cause. This is why it’s really important to keep active and mobile too.
The pain relief your doctor may offer will depend on what’s causing your pain, how severe it is and whether a medicine is suitable for you. Most people with acute (short-term) back pain will recover fairly quickly, within a few weeks.
The information below is an overview of the pain relief medicines your doctor may suggest. If your pain is very severe, is getting worse or is seriously affecting your quality of life, your GP may refer you to a specialist pain service or clinic for more specialist help.
Pain relief for lower back pain
If you have low back pain, your GP may suggest you take an over-the-counter NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen. If this doesn’t help, your doctor may prescribe a different NSAID or another type of painkiller that may work better for you. They will prescribe the lowest dose to take for the shortest period of time. NSAIDs can cause stomach problems such as indigestion, which causes pain and discomfort, bloating and nausea. NSAIDs can also cause stomach ulcers and bleeding. So, your doctor may also prescribe another medicine to protect your stomach while you’re taking the NSAID.
You could try an NSAID cream or gel and apply it to the affected area. The advantage of using a cream is that it’s far less likely to cause any stomach problems. But creams and gels only work where you apply them. For example, although an ibuprofen tablet might help pain in both your back and knee, you would need to apply a cream to both places.
If you’re not able to take an NSAID, your doctor may prescribe a medicine called an opioid (for example, codeine). You might have this with or without paracetamol. Paracetamol isn’t thought to help much when used alone for treating lower back pain. But it works well when combined with other medications.
There’s a risk of becoming dependant on codeine, and it can also cause constipation. Your doctor will take this into consideration and explain the risks and side-effects to you.
Medicines for muscle spasm
If you’re having muscle spasm, your doctor may prescribe a medicine called a benzodiazepine (for example, diazepam) to relax your muscles. Benzodiazepines are usually prescribed as a short course – one tablet up to three times a day for up to five days.
Diazepam is prescribed for a short time because there can be problems with withdrawal symptoms and dependency if you take it for a long time. Withdrawal symptoms include anxiety, difficulty sleeping, confusion, loss of appetite, sweating and heart palpitations.
All medicines come with the risk of side-effects. These are the temporary unwanted effects of a medicine. The main side-effects of taking diazepam are feeling drowsy and being less able to concentrate. It’s very important to follow your doctor’s advice about driving – especially if the advice is not to drive. Even if you only take diazepam at night, it can affect your ability to drive the following day.
Heat and ice for back pain
A hot water bottle or heat pad may help ease muscle spasm and pain. Make sure your skin is protected – don’t put heat pads directly on your skin. You can buy pads that you put over your clothing on the area that hurts. These are available from pharmacies and last for several hours.
Ice packs may also be helpful, especially in the first few days of any injury. Make sure you wrap the ice pack in a towel to protect your skin. You can apply the pack to the area that hurts for 15 minutes at a time.
Pain relief for lower back pain with sciatica
Sciatica is when you have pain in your lower back, buttocks and down one or both legs. If you have sciatica and the above treatments haven’t controlled the pain, your doctor may prescribe a medicine for treating what is called neuropathic pain. This is pain that is thought to be caused by nerve damage or by your nerves becoming more sensitive to pain.
These medicines include amitriptyline, duloxetine, gabapentin and pregabalin. If you’re not able to take tablets, your doctor may suggest using a cream called capsaicin instead.
You’ll have a follow-up appointment with your doctor to see how well your medicine is working and to talk about any problems or side-effects. It can take a little while (sometimes a few weeks) to find the dose that works for you.
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Other helpful websites
- emc: electronic medicines compendium
www.medicines.org.uk
- emc: electronic medicines compendium
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Sources
- Back pain – low (without radiculopathy). NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2020
- Musculoskeletal lower back pain. BMJ Best Practice. bestpractice.bmj.com, last reviewed October 2018
- Neuropathic pain in adults: pharmacological management in non-specialist settings. National Institute for Health and Care Excellence (NICE), updated September 2020. nice.org.uk
- Non-steroidal anti-inflammatory drugs. NICE British National Formulary. bnf.nice.org.uk, accessed December 2020
- Ibuprofen 200mg tablets. electronic medicines compendium. medicines.org.uk, last updated April 2020
- Ibugel. electronic medicines compendium. medicines.org.uk Last updated February 2020
- Analgesia – mild-to-moderate pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2020
- Diazepam. NICE British National Formulary. bnf.nice.org.uk, accessed December 2020
- Hypnotics and anxiolytics. NICE British National Formulary. bnf.nice.org.uk, accessed December 2020
- Diazepam tablets BP 5mg. electronic medicines compendium. medicines.org.uk, last updated September 2019
- Ice packs for back pain relief. SPINE-health. spine-health.com, last updated September 2012
- Sciatica (lumbar radiculopathy). NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2020
- Neuropathic pain – drug treatment. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2020
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Author information
Reviewed by Liz Woolf, Freelance Health Editor, December 2020
Expert reviewer, Justin Hayde–West, Chief Pharmaceutical Officer’s Clinical Fellow at Bupa UK
Next review due December 2023
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