Which oral medications are
prescribed for low back pain?
Nonsteroidal anti-inflammatory drugs (NSAIDs)
are frequently taken to relieve low back pain. They serve a dual purpose,
acting as both an anti-inflammatory agent and an analgesic. Prostaglandins
sensitize nociceptors to painful stimuli and potentiate the algesic effect of
bradykinins. By inhibiting the enzyme cyclo-oxygenase (COX), NSAIDs inhibit
prostaglandin synthesis and analgesia occurs.
Side-effects of NSAIDs include gastric
irritation, renal dysfunction, platelet inhibition, hepatic dysfunction, and
tinnitus. New COX-2 specific inhibitors have been devel-oped which maintain the
analgesic, anti-inflammatory and beneficial effects on the stomach of COX-1
(i.e., increased gastric blood flow, increased protective gastric mucus
secretion, decreased gastric acid secretion) while decreas-ing the detrimental
side-effects of gastric ulceration and bleeding.
Tricyclic antidepressant drugs (TCAs) can be
used as adjuncts to analgesic therapies. They decrease the reup-take of
serotonin and norepinephrine, which are neuro-transmitters in the descending
inhibitory spinal cord pain neuropathways. Thus, TCAs have analgesic properties
of their own. Other effects of TCAs that can be used in pain management include
sedation (fostering a good night’s sleep), potentiation of opioid analgesics,
and mood eleva-tion. If there is a strong neuropathic component to the pain, anticonvulsant
agents may be beneficial.
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