Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease. -Sir William Osler
Finding the best medication to treat all types of low back pain is an impossible task given the variability of people and the multidimensional nature of this condition. Finding the right medication for your low back pain might not be so impossible if your individual circumstances are carefully taken into consideration. Over 80 percent of people with chronic low back pain take at least one type of medication to help relieve the pain. The top three medications used are: anti-inflammatory medications, opioid medications, and antidepressant medications. Of course, many other medications are utilized for back pain like acetaminophen, muscle relaxants, steroids, and antiepileptic medications. With so many choices, how can you find the right one that is going to work for you?
What works for one person is not necessarily going to work for another person because everyone is different. The responses to medications are difficult to predict because of the infinite combinations of influential factors contributing to the painful experience. But by following the trends and considering the three basic subgroups of people who have low back pain, you might be able to anticipate which medication will work best for you.
Those with a new episode or recent exacerbation of low back pain will most likely benefit from an anti-inflammatory medication (NSAIDs) that can extinguish the fire of pain and swelling before it gets out of control. For this reason, the NSAIDs are the first choice of many doctors for treating low back pain and should be your top choice too. However, some people cannot take a NSAID because of bleeding risk or stomach problems. In which case, alternatives medications to NSAIDs like opioids, acetaminophen and muscle relaxants should be considered. All of these medication seem to work equally well for the majority of individuals, but not all individuals.
If you have pain radiating into your leg, then you might want to consider different medications which specifically target nerve irritation. The antiepileptic medications like gabapentin or pregabalin might work better for you. Steroids that are injected into the epidural space of the spine in order to bathe the nerve can also help a great deal if the pain is new. Some specific opioid medications are also most effective when nerve pain is being experienced, such as tramadol or tapentadol. Nerve pain responds better to some medications than others; so, individual medication choices should vary according to whether or not you are having nerve pain.
Another particular subgroup of individuals who have low back pain is the group of people that have an underlying anxiety and depression disorder. These individuals do not respond favorably to opioids or anti-inflammatory medications on a consistent, reliable basis. If you have anxiety or depression, then relieving your anxiety or depression (or both) might be the key to relieving your low back pain too. In order to address both the back pain and the psychological distress, an antidepressant medication could be the best medication choice for you.
Finding the best medication to treat low back pain requires an in depth evaluation of the individual as opposed to a blanket prescribing habit that is applicable to all. Even the best medical evidence does not account for individual variation. However, many people with low back pain fall into three main categories: acute pain, nerve pain, and pain associated with anxiety and/or depression. Based on these three subgroups of individual, you might be able to predict which medication is more likely to relieve your low back pain.