Treatments for back pain: Pharmacological therapy

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Analgesics Non steroideal antiinflammatory drugs Muscle relaxants Other Neuroreflexotherapy (NRT) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Other

Use of other pharmaceutical drugs has been proposed, such as steroideal anti-inflammatory drugs - that is, cortisone derivatives-, opioids and antidepressants, and colchicine.

Steroideal antiinflammatory drugs

Steroids are very potent anti-inflammatory drugs, but their risks are also important and impede their systematic use.

Their most frequent adverse effects are related to digestive tract disorders, such as stomach burn or bleeding ulcers. They also increase blood glucose, worsening diabetics' stability, generate obesity and protein destruction, causing long-term muscular atrophy and capillary fragility, with onset of hemorrhages.

Some of the existing recommendations based on scientific evidence advise them by intramuscular administration (not orally) and only briefly if symptoms are very intense and refractory to nonsteroideal anti-inflammatory therapy. The existing recommendations based on scientific evidence coincide in stating that the few available studies suggest that oral steroids are not effective for the treatment of back pain.

Opioids

Opioids are morphine-derived drugs. They are very potent analgesics. Their use should only be considered for very intense pain episodes, when other drugs have proven useless. Opioids are dangerous and have important adverse effects such as drowsiness, decreased reaction time, clouded judgement and potential physical dependence. Some of the existing recommendations based on scientific evidence point out that these symptoms appear in about 35% of patients. The existing recommendations based on scientific evidence establish that opioids appear to be no more effective in relieving back pain symptoms than safer analgesics such as paracetamol, aspirin or other nonsteroideal anti-inflammatories. Therefore they recommend avoiding their use for back pain.

Colchicine

Colchicine is a drug used for treating rheumatism. It's most common side effects (gastrointestinal irritation and skin problems) are reported by one third of patients. Most severe side effects include decrease in blood cell count. Available evidence does not show Colchicine to be effective for treating back pain.