If you ask Google about suitable medication against back pain, you’ll see up to 40 different preparations being offered in online pharmacies. How is anyone meant to navigate their way through this drug jungle? There are some clear recommendations for which medicines help against back pain and which ones, in effect, don’t. These can be found in the German and Austrian guidelines for non-specific back pain, for example. These guidelines are compiled by a large team of experts, comprising physicians, physiotherapists, psychotherapists and scientists. So these are recommendations on which you can rely. As these guidelines can sometimes seem rather complicated, they have been edited in a simplified and understandable way.
Tablets, injections and so on: why there are limits to relieving back pain through medication
Medicines against back pain work on a purely symptomatic basis. This means they don’t treat the cause of your back pain. That is why you should only take them – if at all – as a supportive measure to non-medicine-based treatment methods (which can be found in this article) .
On the whole, medicines only help moderately well against back pain .
That’s why it is important for you to be well-informed about the side effects, and to weigh up with caution the additional value they might bring. Furthermore, it is good to have a clear goal in mind. For example, to able to do 3-km walks again. By having this goal, you’ll be able to see whether the medicines are having the desired effect. You should also ALWAYS discuss taking pain relief medication with your GP first. In doing so, you should both also regularly check whether [1,2]:
- you display any of the potential side effects
- the dose is still right
- the effectiveness and medicine tolerance justify continuing with the treatment
The power of chilli and Ibuprofen: what really helps
The following recommendations are exclusively for acute and non-specific back pain. So not for chronic back pain. And also not for back pain that has a clear cause, such as a vertebral fracture. In discussion with your GP, you can take the following medicines as a supporting measure :
- NSAR (non-steroid anti-rheumatic drugs):
The classic active ingredients of this group of medications are Diclofenac, Ibuprofen and Naproxen. The difference between these three ingredients with regard to their pain-relieving and function-enhancing effectiveness is insignificant. Remember that this effectiveness only lasts for a few hours.
You should never exceed the daily dose of up to 1.2 g Ibuprofen, 100 mg Diclofenac or 750 mg Naproxen. Unfortunately, NSARs can have severe side effects. Your digestive tract in particular can be affected (sickness, stomach ache etc.). If you are sensitive in this regard, asking your doctor to prescribe a form of stomach protection (proton pump inhibitors) is a good idea, as well. As a general rule, when taking NSARs, always take the lowest dose and only for a short time period if possible. You should only switch to using a different group of medicines if you are not allowed to take NSARs.
- Opioids :
Your GP should only prescribe opioids for acute back pain for you if treatment using NSARs doesn’t work, or you are not allowed to take them for some other reason. After a maximum of 4 weeks, your GP should ascertain whether it is still suitable for you to continue taking them, or if the dose is still right. For acute back pain, this medicine should always be taken orally in tablet form. So not as a type of “pain plaster”.
- Capsaicin plasters and creams combined with a form of physical activity, such as exercising or doing stretches [1,3]:
Capsaicin is a substance found in paprika and chilli peppers and is what produces the spiciness and burning effect from these fruits. It was already being used as a healing agent 100 years ago, particularly because it has an inhibiting effect on the pain receptors in your tissue. This means you feel less pain.
Paracetamol and injections in your back: what will not help you
As you may have realised from the section above, it is possible to tally up the medicines that really do help against back pain on one hand, or rather, on 3 fingers. As a result, there is a long list of medicines that you can confidently forget about taking for acute, non-specific back pain. Either because they don’t relieve your pain or because they come with worrying side effects. And in the worst case, even both. Here you can read about which medicines won’t help you :
- Any kind of injection into your back muscles or vertebral joints :
Injections, filled with Cortisone, pain relievers or anaesthetics in and around the spine are common practice in orthopaedic practices. This is completely astounding, however, as no definite effectiveness has been proven. Pain relievers that you take in tablet form are just as effective and don’t come with the risk of infection, such as from abscesses,or even nerve damage. This is the reason why doctors and scientists recommend steering clear of this type of injection.
Pain gels and pain plasters: what will not help you
- Cream or gel-based NSARs, such as Diclofenac gel :
Although people with back pain like to use these, and often at that, there isn’t any proof whatsoever that these creams and gels have any effect. Furthermore, they can cause localised hypersensitivity reactions, such as itching, redness, skin rash or skin burns.
- Plaster-based opioids
- Central muscle relaxants (Methocarbamol, Orphenadrine, Tizanidine, Pridinol Mesilate) :
The concept of these medicines is to act as a sort of dampener in your brain. The result of this is that your muscles relax. Unfortunately, these muscle relaxants have significant side effects on your digestive tract (e.g. impaired liver function) and your nervous system (e.g. dizziness, fatigue, vertigo). This might also be accompanied by allergic reactions. Although these medicines have been proven to work in at least the short term, doctors and scientists advise against using them.
- Medicines against epilepsy (anticonvulsants)
- Flupirtine (warning: last year this medicine was taken off the German market due to its side effects )
- Devil’s claw
- Combination preparations that contain uridine monophosphate, vitamin B12 and folic acids (e.g. Keltican® forte)
- Comfrey-based creams
What you have learnt about back pain medication
You now know that, as a general rule, medicines for treating back pain are limited in their potential. If anything, they provide short-term relief from symptoms, which must, without fail, be combined with exercise and non-medicine-based treatment methods.
You also now know that there is proof that NSARs – and in special cases opioids and capsaicin creams – can help with acute and non-specific back pain. All other forms of medication, including injections, plasters, creams and tablets, have no proven effectiveness in any way. That is why they are not recommended by doctors and scientists.
Important to note:
This article contains general recommendations only and must not be used for self-diagnosing or self-treatment. It is not a replacement for visiting your GP.
 Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Nicht-spezifischer Kreuzschmerz – Kurzfassung, 2. Auflage. Version 1. 2017 [cited: 2019-06-06]. www.kreuzschmerz.versorgungsleitlinien.de.
 Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz. Update der evidenz- und konsensbasierten Österreichischen Leitlinie für das Management akuter, subakuter, chronischer und rezidivierender unspezifischer Kreuzschmerzen 2018 – Kurzbezeichnung Leitlinie Kreuzschmerz 2018, , Langfassung, 1. Auflage, Version 1, 2018 [cited: 2019-07-17] https://www.sozialministerium.at/cms/site/attachments/5/8/5/CH3970/CMS1532068366400/langversion_leitlinie_unspezifisicher_kreuzschmerz_.pdf
Patowary, P., Pathak, M. P., Zaman, K., Raju, P. S., & Chattopadhyay, P. (2017). Research progress of capsaicin responses to various pharmacological challenges. Biomedicine & Pharmacotherapy, 96, 1501–1512.