Mechanical Back Pain Medication

Updated: Aug 27, 2020
  • Author: Debra G Perina, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication Summary

The goal of pharmacotherapy is to reduce pain and inflammation.


Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

NSAIDs are most commonly used to relieve mild to moderate pain. Although the effectiveness of NSAIDs tends to be patient specific, ibuprofen is usually the DOC for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.

Ibuprofen (Ibuprin, Advil, Motrin)

DOC to treat mild to moderate pain if no contraindications exist.

Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Anaprox, Naprelan, and Naprosyn)

For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.


Muscle relaxants

Class Summary

These agents reduce tonic somatic motor activity of the muscle.

Carisoprodol (Soma)

Short-acting medication that may have depressant effects at spinal cord level.

Skeletal muscle relaxants have modest short-term benefit as adjunctive therapy for nociceptive pain associated with muscle strains and, used intermittently, for diffuse and certain regional chronic pain syndromes. Long-term improvement over placebo has not been established.

Cyclobenzaprine (Flexeril)

Skeletal muscle relaxant that acts centrally and reduces motor activity of tonic somatic origins influencing both alpha and gamma motor neurons.

Structurally related to tricyclic antidepressants and thus carries some of the same liabilities.



Class Summary

Pain control is essential to ensure patient comfort, to promote pulmonary toilet, and to aid physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained injuries.

Acetaminophen (Tylenol, Panadol, Aspirin Free Anacin)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, in those with upper GI disease, or in those who are taking oral anticoagulants.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

A drug combination indicated for the relief of moderate to severe pain.

Tramadol (Ryzolt, Ultram, Ultram ER)

Tramadol binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain from throughout the body.

Duloxetine (Cymbalta)

Potent inhibitor of neuronal serotonin and norepinephrine reuptake. Indicated for chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain. [27]