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.