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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 June 2021

Your GP may recommend medicines to help ease your back pain. Pain relief can help ease the symptoms but they won’t treat the cause. This is why it’s really important that you 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 number of weeks.

If your pain is very severe or gets worse or is affecting your quality of life, your GP may refer you to a specialist pain service or clinic for more specialist help.

If your GP prescribes a medicine for your back pain, they will be able to answer any questions you have about it. These could include questions about side-effects, interactions or how long you should take it for. The information below is an overview that explains the pain relief medicines your doctor may suggest.

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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 work, your doctor may prescribe a stronger NSAID. They will prescribe the lowest dose to take for the shortest period of time. NSAIDs can cause gastric (tummy or digestive) problems such as indigestion, which causes pain and discomfort, bloating and nausea. NSAIDs can also cause stomach ulcers and bleeding. Therefore, your doctor may also prescribe treatment to protect your stomach (for example, another medicine) to take 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 gastric side-effects. However, cream and gel only work where you apply them. For example, although one ibuprofen tablet might help both your back and knee pain, you would need to apply the 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 work very well when used alone for treating lower back pain. However, it can be effective when combined with other medications.

There’s a risk of becoming dependant on codeine, and it can also cause constipation. This can cause you to strain when going to the toilet, and make back pain worse. Your doctor will take this into consideration and explain the risks or 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 it is taken for a long time. Withdrawal symptoms can include anxiety, depression, trouble in concentrating 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 it is not to drive.

Heat and ice for back pain

A hot water bottle or heat pad may help ease muscle spasm and pain. You can buy pads from the pharmacy, which you put over your clothing on the area that hurts. These last up to several hours. Make sure your skin is protected – don’t put heat pads directly on your skin.

Ice packs may also be helpful, especially in the first few days of any injury. Apply the pack to the area that hurts for 15 minutes at a time. Make sure you wrap the ice pack in a towel to protect your skin.

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 when pain 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 a cream instead. You’ll have a follow-up appointment with your doctor to see how well the medicine is working and to talk about any problems or side-effects. It can take a little while (a number of weeks) to get the right dose that works for you.


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Related information

    • Low back pain (without radiculopathy). NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2017
    • Neuropathic pain in adults: pharmacological management in non-specialist settings. National Institute for Health and Care Excellence (NICE), www.nice.org.uk, last updated April 2018
    • Musculoskeletal low back pain. BMJ Best Practice. bestpractice.bmj.com, last updated June 2018
    • Neuropathic pain – drug treatment. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2015
    • Sciatica (lumbar radiculopathy). NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2017
    • NSAIDs – prescribing issues. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2015
    • Assessment of dyspepsia. BMJ Best Practice. bestpractice.bmj.com, last reviewed June 2018
  • Produced by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, July 2018
    Expert reviewer, Justin Hayde–West, Chief Pharmaceutical Officer’s Clinical Fellow at Bupa UK
    Next review due July 2021



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