Pain medications are frequently used to treat back pain. Increasingly, however, doctors and the general public are learning that these drugs have many side effects, particularly when taken for months or years at a time. In addition, the strongest pain relievers have the greatest risk of abuse and dependence.
To minimize side effects and the risk of dependence, doctors treat all nonsevere pain using a pain ladder that was originally developed for cancer-related pain. On the ladder, you start with the gentlest drugs that have the fewest side effects, then work up to the big guns only if absolutely essential.
Most of the nonprescription drugs in the first rung fall into a group known as nonsteroidal anti-inflammatory drugs, or NSAIDs. The most popular are ibuprofen/Advil/Motrin (400 to 600 milligrams every eight hours) and naproxen/Aleve/Naprosyn (220 to 500 milligrams twice per day). NSAIDs are great for back pain but can cause problems in people with kidney disease or heart disease. They can also irritate the stomach and even cause ulcers.
If you can’t take NSAIDs for some reason you can instead try acetaminophen/Tylenol. This medication is very safe if taken at recommended doses (500 to 1000 milligrams every six to eight hours). If you take more than 4000 milligrams over twenty-four hours, however, you will be at risk for life-threatening acute liver failure. If you already have liver disease, you should ask your doctor about safe doses of acetaminophen.
The first rung also contains prescription drugs that may help relieve pain, like antidepressants (duloxetine/Cymbalta, amitriptyline/Elavil), muscle relaxants (cyclobenzaprine/Flexeril), and medications for nerve pain (gabapentin/Neurontin, pregabalin/Lyrica).
The second rung on the ladder contains weak opioids, like codeine, while the third rung contains stronger opioids, like hydrocodone (found in Vicodin), oxycodone (found in Percocet and Oxycontin), and methadone. All require prescriptions. Because these drugs can be addictive, they should be used only for very short courses (a few days) or when all other long-term options have failed. The current opioid epidemic is related, in part, to the overuse of these medications for pain that could be treated using other medication classes combined with physical therapy, massage, and other non-medicinal interventions.
You also have fever or chills. Your symptoms may indicate an infection in or around the spine. The most worrisome location is adjacent to the spinal cord itself, where an infection can press against the cord and cause permanent nerve damage. A doctor will order some blood tests and may perform an MRI of your spine. The treatment of a spine infection is usually several weeks of antibiotics. If the infection is near your spinal cord, it may need to be surgically drained. One alternative explanation for these symptoms (which still warrants an E.R. visit) is a kidney infection, which causes fever and lower back pain. This type of infection is even likelier if you also feel the frequent need to pee. The treatment is antibiotics.
You are having occasional spasms of severe lower back and pelvic pain. You may be passing a kidney stone. These stones form in the kidneys, often in response to dehydration, and then get pushed into the very narrow tubes that drain to the bladder. The stones don’t really fit through those tubes, so they get stuck and form painful blockages. The tubes periodically try to push the stones through, causing severe pain. You may also notice some blood in your urine. The diagnosis is confirmed with a CT scan or ultrasound. The treatment is intravenous fluids (to increase production of urine, which will push the stone along), pain medication, and medication to enlarge the tube where the stone has gotten stuck. If the stone is too large to pass on its own, doctors may perform a procedure (using ultrasound or a laser) to break the stone into smaller fragments that can pass more easily.
You were in a car accident or had some other major physical trauma. Hopefully you know better than to try to skip the E.R. after a major injury. You could have fractured one or more vertebrae and may also have damage to your internal organs, like your kidneys, liver, or spleen. Get checked out before it’s too late.