Pain
Certain medications are better than others for managing spine pain
In the journals
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Some drugs are safer and more effective for managing spine pain in people ages 65 and older, according to research published online June 27, 2022, by Drugs and Aging.
Investigators reviewed 138 trials that examined how various drugs help with spine related pain caused by muscular, arthritic, or nerve pain in the neck, midback, and low back. The results are a helpful guide for physicians and older adults. Here are the key findings:
Over-the-counter drugs: Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin IB) are safe and effective, although NSAIDs are more helpful. NSAIDs should be taken in the lowest effective doses to avoid side effects.
Nerve pain medication: Gabapentin (Neurontin) and pregabalin (Lyrica) may help reduce neck and back nerve pain, especially sciatica. Begin with low doses to avoid daytime drowsiness and fall risk.
Muscle relaxants. Tizanidine (Zanaflex) and baclofen (Lioresal) may reduce pain from muscle spasms. People with liver disease should avoid tizanidine, and those with kidney disease should take baclofen in lower doses. Also, avoid the drugs carisoprodol (Soma), chlorzoxazone (generic only), cyclobenzaprine (Amrix), metaxalone (Metaxall), methocarbamol (Robaxin), and orphena-drine (generic only) because of their risk for drowsiness and falls.
Antidepressants. Duloxetine (Cymbalta), a selective serotonin-norepinephrine reuptake inhibitor, appears safe for spine-related nerve pain like sciatica. Avoid most tricyclic antidepressants because of potential side effects. Nortriptyline (Pamelor) and desipramine (Norpramin) are better tolerated at lower doses.
Corticosteroids. A short course may help, but the evidence is not strong.
Traditional opioids. Avoid due to addiction risk.
Image: pedro arquero/Getty Images
About the Author
Matthew Solan, Executive Editor, Harvard Men's Health Watch
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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