Back Pain Medications

Updated Oct. 2, 2023

Treatment for back problems depends on a number of factors, including the findings of diagnostic tests. In many cases, medications to relieve pain and inflammation, slow bone loss or even slow or halt the progress of inflammatory disease are an important part of a back treatment plan. Depending on your diagnosis, treatment for your back pain may include one or more of the following medications.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Including more than a dozen different drugs, many of which are available without a prescription, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help ease arthritis pain and, in higher doses, inflammation. They may also be useful for relieving back pain from muscle strain and other causes. NSAIDs come in oral form, and topical preparations are also available, including diclofenac sodium (Voltaren).

Analgesics. Analgesics are among the most commonly used drugs for many forms of arthritis and other causes of back pain. Unlike NSAIDs, which target both pain and inflammation, analgesics are designed purely for pain relief. For that reason, they may be safe for people who are unable to take NSAIDs due to allergies or stomach problems, for example. When taken as directed, analgesics also are an appropriate, and possibly safer, choice for pain not accompanied by inflammation.

Topical Rubs. If back pain is in the soft tissues, you may find relief from an analgesic salve, rub or balm available over the counter under trade names such as Aspercreme, Ben-Gay, Capzasin-P, Eucalyptamint and Icy Hot. Although these topical preparations, which work through a variety of active ingredients, are usually used on peripheral joints, such as the knees or hands, you might find them useful and safe for back pain.

Muscle Relaxants. These are drugs used to ease muscle spasms. For back pain relief, they are often prescribed along with NSAIDs. Commonly prescribed muscle relaxants include cyclobenzaprine (Flexeril), orphenadrine and carisoprodol (Soma). Muscle relaxants may cause drowsiness, so they may be helpful if back pain keeps you awake at night.

Corticosteroids. These quick-acting drugs, similar to the cortisone made by your own body, are used to control inflammation. If inflammation is due to a systemic inflammatory disease, such as polymyalgia rheumatica or rheumatoid arthritis in the back, your health care provider may prescribe oral corticosteroids. If inflammation is limited to an inflamed joint in the spine, you may receive a corticosteroid injection directly into the inflamed joint.

Disease-modifying antirheumatic drugs. Disease-modifying antirheumatic drugs (DMARDs) work slowly to modify the course of inflammatory disease. Different DMARDs may be useful for a number of different forms of arthritis that may affect the spine, including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.

Biologic response modifiers. These are also disease-modifying medications, but unlike other DMARDs, each biologic or its biosimilar blocks a step in the inflammation process without suppressing the entire immune system. Biologics and biosimilars are approved to treat RA, PsA, ankylosing spondylitis, gout, lupus, juvenile arthritis and nonradiographic axial spondylitis. While numerous biosimilars are in use around the world and many have been approved in the U.S., only those for rituximab and adalumumab are available so far in the U.S.

Janus kinase inhibitors. These drugs, like biologics, target specific parts or pathways in the immune system instead of suppressing the whole system. Unlike biologics, they are synthetics and are taken orally. Janus kinase inhibitors (JAKi) are approved to treat psoriatic arthritis and psoriasis, rheumatoid arthritis, ankylosing spondylitis, juvenile arthritis and nonradiographic axial spondyloarthritis.

Osteoporosis medications. Osteoporosis medications are those used to slow the loss of bone (antiresorptive drugs, including bisphosphonates, calcitonin, the biologic denosumab [Prolia], estrogen and estrogen antagonists) or help the body build new bone (anabolic drugs, including teriparatide (Bonsity, Forteo) and abaloparatide (Tymlos). Although they are not used specifically to treat back problems, strong bones are less prone to fracture. Bisphophonates are also used to treat Paget's disease of the bone, which can also affect the spine.

Fibromyalgia medications.  Doctors prescribe medications from a variety of drug classes to treat fibromyalgia. Only three of these drugs — the anti-seizure medication pregabalin (Lyrica) and two antidepressants, duloxetine (Cymbalta) and milnacipran (Savella) — are FDA-approved to treat fibromyalgia. Many others are used off-label in fibromyalgia treatment because they have been shown in clinical trials to ease different symptoms. These include some other antidepressants, muscle relaxants and analgesics.