What’s the best medication for back pain?

Patients often ask this, especially if they’ve recently surveyed the multitude of choices at their local pharmacy.

When it comes to back pain, NSAIDs can be extremely useful when used properly.

There are 7 different chemical structural types into which NSAIDs can be classified. While some are ‘prescription only’, understand that the mechanism of all NSAIDs (nonsteroidal antiinflammatory drugs) is: to reduce swelling, without steroids (cortisone or similar.)

What’s the downside? They don’t affect everyone exactly the same, but NSAIDs in general have the potential to affect your blood pressure, and NSAIDs all have the potential to cause bleeding in the GI tract, although some (ie, celebrex) may provide less risk to people with stomach or GI problems.  NSAIDs are generally not prescribed to people with aspirin allergies or kidney disease.

The upside? NSAIDs won’t make you ‘high’ and NSAIDs do not have the addictive potential as that of  painkillers such as percocet, vicodin or oxycontin (these particular medicines block pain, but do nothing to reduce swelling or inflammation.) On the other hand, NSAIDs work by blocking a mechanism causing inflammation, swelling and pain.

An NSAID is often one of the first medications prescribed for back pain and sports injuries.

Which one of those NSAIDs works best? Answer: none of them is a ‘super drug’ over all the rest. Some may last longer in the blood stream than others (ie, aleve lasts longer than motrin) however there’s no difference in their ability to stop swelling and inflammation.

Check with your physician if you have a problem causing you to take an over-the-counter NSAID for more than a week: its time to get properly diagnosed for more specific treatment.

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Dr. Oz on Pain

I just read an interesting article by Dr. Mehmet Oz in a recent issue of Time Magazine.

In it he mentions the term pain numerous times in the context of physical, mental and spiritual aspects of health. While I generally agree with Dr. Oz’s article, there are a couple of issues that I’d like to clarify.

The first is the fact that pain is not a diagnosis. Simply diagnosing someone as having “chronic pain” is almost as vague as your auto mechanic saying “your car’s broken” or your plumber saying “you’ve got a leak.” It’s important to understand the specific diagnosis – is there a herniated disk, a fracture, arthritis, or pinched nerve, for example. Each has a different prognosis, and warrants different treatment options. Sometimes we physicians don’t have all the answers, but that’s when its time to get a second opinion or see a specialist. If a specific diagnosis can’t be made, its still important to be as specific as possible, ie “persistent low back pain due to disk herniation” rather than just a generic : “chronic pain.”

The second is the importance of how back pain affects how we function as a society.  Dr. Oz didn’t mention that while low back pain costs our nation over $75 billion every year, most of this is due to lost productivity, wages, and costs related to administrative and legal expenses. The actual medical costs (including scans, medications and even surgeries) make up a small fraction of the total.

Spine Physiatrists are physicians with specialized training to diagnose and treat people with low back pain, but their ultimate goal is to optimize your level of functioning- for work, tasks at home, or sports.  They realize that function and pain are not mutually exclusive when it comes to recovering and rehabilitating from back pain.

Sometimes pain doesn’t interfere with the sports or activities you love or the tasks that have to get done, but if low back pain is keeping you from functioning – think about seeing a Physiatrist.

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