7 Best Lower Back Medications
Medically reviewed by Kristie Reed, PharmD
Back pain—which can include achiness and nerve pain—is a common problem for adults of all ages. Chronic low back pain affects up to 23% of adults worldwide, and the most common causes of low back pain are repetitive trauma and overuse injuries.
To get back pain relief, treatment options range from over-the-counter (OTC) painkillers and topical pain relievers to lifestyle changes like exercising regularly. Here's what you need to know about helpful lower back pain medications and when to see a healthcare provider.
1. NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation in the body. Examples include Advil (ibuprofen) and Aleve (naproxen). While ibuprofen is an initial recommendation when you first develop back pain, it may not be effective for all types of back pain.
One review found that NSAIDs were only slightly more effective compared to placebo treatments for short-term back pain reduction. Because NSAIDs help lower inflammation, they may be more helpful for back pain caused by inflammatory conditions like arthritis.
Most healthy adults can safely take NSAIDs for occasional pain. NSAIDs can also produce side effects like stomach ulcers and kidney dysfunction.
2. Acetaminophen
Tylenol (acetaminophen) is an OTC pain reliever and fever reducer. It’s often recommended for chronic low back pain because it has a low risk of side effects.
Acetaminophen may be more effective when taken with NSAIDs for back pain and has also been found to reduce the need for opioid medications for severe back pain. This medication may cause side effects such as skin rashes, anemia, liver toxicity, and liver dysfunction.
3. Muscle Relaxants
Muscle relaxants are a type of pain reliever used to relieve back pain caused by muscle tension. They work by relaxing the muscles in the back, which can improve pain and allow for easier movement. Common muscle relaxants include Flexeril (cyclobenzaprine), Lioresal (baclofen), and Zanaflex (tizanidine).
Muscle relaxants cause all of the muscles in the body to relax and may cause drowsiness. It's best to try your first dose at night time to see how you feel. Muscle relaxants should only be taken for a short time because they carry a risk of dependence when used long-term.
4. Anti-Seizure Medications
Some people may experience chronic neuropathic pain—a type of pain caused by damage to the nerves that carry information between your spinal cord and brain from other parts of your body. For this type of pain, a healthcare provider may prescribe an anti-seizure medication, which is also called an anticonvulsant.
Neuropathic pain in the back often causes shooting pain sensations down the hip or leg. Sciatica is an example of neuropathic back pain.
Anti-seizure medications work by interrupting the pain signals being sent to the brain. Examples of anti-seizure medications used in chronic pain management include Neurontin (gabapentin) and Lyrica (pregabalin). Possible side effects include drowsiness, dizziness, and peripheral edema (swelling).
5. Antidepressants
Antidepressant medications are sometimes used to treat certain kinds of back pain. These drugs are commonly used to treat depression and anxiety, but low doses may help reduce back pain even when a person’s not feeling depressed. Like antiseizure drugs, they can interrupt pain signals being sent to the brain, which may help decrease back pain.
Examples of antidepressants that are used to treat chronic pain include Elavil (amitriptyline), Pamelor (nortriptyline), Cymbalta (duloxetine), and Effexor (venlafaxine). Possible side effects related to antidepressant use include sleep disturbances and sexual dysfunction.
6. Opioid Pain Relievers
Opioid pain medications may be used to treat severe, acute back pain. They are sometimes prescribed after back surgery or to relieve pain from a new injury. They’re not appropriate for long-term use because they’re highly addictive and carry a serious risk of dependence and abuse.
A 2018 study found that opioid medications were no more effective at treating chronic back pain than non-opioid medications. They also caused significantly more side effects than non-opioid pain medications.
Examples of common opioids include morphine, oxycodone, and hydrocodone. Possible side effects of opioids include gastrointestinal distress, tolerance, abuse, and depression. When used over a long period of time, opioids have been found to also lead to:
Difficulty completing activities of daily living
A lower chance of being able to return to work
Poor pain outcomes
7. Topical Pain Relievers
Topical pain relievers like creams, gels, and patches can be applied directly to the skin on the back. If you’re unable to tolerate oral pain medications due to side effects, a healthcare provider may recommend a topical pain reliever to ease your symptoms.
Two types of topical pain relievers used for back pain are capsaicin and lidocaine, which are available in creams and patches. Topical treatments used in conjunction with oral pain medications have a low risk of side effects. Topical back pain treatments may cause side effects like rashes, swelling, or a burning sensation. These patches should never be worn longer than 12 hours.
Non-Medication Pain Relievers
You may be able to ease your back pain with non-medication options. These other methods include lifestyle changes and treatments.
Lifestyle
Making adjustments to your lifestyle can be beneficial for achieving back pain relief. The following practices may help ease some types of back pain:
Being physically active—when it's safe to do so—by doing activities like core strengthening exercises, regular stretching, and yoga
Eating according to an anti-inflammatory diet and one that contains calcium and vitamin D, which are nutrients for bone health support
Getting adequate sleep
Maintaining a healthy weight to prevent putting extra weight on your back
Never smoking
Using heat therapy or ice packs
The lifestyle factors you could change will vary based on whether you have acute or chronic pain. For example, while cold packs, heat therapy, and movement can be helpful for either type of pain, you may have to utilize more medical-based treatments for chronic pain.
Treatment
Sometimes, complementary medical treatments may be necessary for getting relief from low back pain. Those might options include:
Acupuncture, a practice where a professional inserts tiny needles into certain areas of your skin
Chiropractic care and spinal manipulation, where a professional adjusts and massages your spine and surrounding back muscles
Cognitive-behavioral therapy, which can be helpful for learning how your thoughts, feelings, and actions play a role in your pain
Transcutaneous electrical nerve stimulation (TENS) unit, a machine that small pulses of electricity to the nerves for pain reduction
Causes of Back Pain
Back pain can result from inflammation, medical conditions that affect the spine, nerve pain, and more. Here are some of the most common causes of back pain:
Injury or damage to the back or spine: Injuries or damage to the back muscles and spine—like sprains, herniated discs, and spinal stenosis—can cause your back to ache. Back surgery can also cause short-term back pain.
Medical conditions: Some conditions like arthritis, osteoporosis, tumors, kidney infections, and fibromyalgia can cause back pain.
Nerve pain: One study found about 16% to 55% of individuals with chronic low back pain have possible nerve-related pain. Nerve pain usually feels sharp and can travel to the hip, knee, or foot.
Obesity: Being overweight or obese is linked to a higher risk of back pain. Carrying extra weight puts pressure on your spine, which can cause your back to ache.
Pregnancy: Most people experience back pain during pregnancy. Hormonal changes, weight gain, and compression of the spine during pregnancy can lead to back pain.
When To See a Healthcare Provider
It's important to talk with a healthcare provider if you're experiencing chronic back pain or sudden, acute back pain. You'll also want to see a provider for the following:
Back or spine redness or swelling
Back pain accompanied by unexplained fever or unintentional weight loss
Back pain after severe blows or falls
Back pain and cancer history
Bowel or urine incontinence
Leg pain going past your knee
Lower extremity weakness or numbness
Severe, uncomfortable pain
Worsening back pain in general
Worsening nighttime pain, including pain that wakes you up
A Quick Review
Back pain is a common condition that injuries, medical conditions, pregnancy, and more can cause. Back pain is commonly treated with pain-relieving medications—like muscle relaxers or NSAIDs—but it’s important to use the right kind.
If you’re experiencing back pain that’s not responding to pain relievers, make an appointment with a healthcare provider. They can recommend medications and other treatments that may be effective for your specific type of back pain.
Frequently Asked Questions
What is the best medication for lower back pain?
Over-the-counter pain medications are best for low back pain, as they are typically first-line treatments.
How do you tell if lower back pain is muscle or nerve?
Nerve pain is often sharp or tingling, while muscle pain feels deep and dull.
What is the best painkiller for spinal stenosis?
The best painkiller will vary individually, but healthcare providers may recommend OTC or prescribed oral and topical painkillers for spinal stenosis.
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