LOWER BACK PAIN DRUG TREATMENT BASICS

Drug

Dosage

Comment

Acetaminophen (Tylenol)

3000 – 4000 mg total daily dose

(1 or 2 XST tabs QID)

1^st line

Safest of all

Use around the clock instead of as needed

2 to 4 weeks duration

Ibuprofen (e.g. Advil, Motrin)

Anti-inflammatory agent (NSAID)

Up to 800mg TID

1^st line

May be more effective than acetaminophen

Use around the clock instead of as needed

2 to 4 weeks duration

Avoid if hypertension, heart failure, GI ulcers, kidney diseases

Naproxen (e.g. Aleve)

Anti-inflammatory agent (NSAID)

500mg BID

1^st line

May be more effective than acetaminophen

Use around the clock instead of as needed

2 to 4 weeks duration

Avoid if hypertension, heart failure, GI ulcers, kidney diseases

Cyclobenzaprine

Muscle relaxant

5 – 10 mg TID

2^nd line

High incidence of CNS side effects (e.g. sedation)

Avoid in seniors (risk of falls)

Limit use to 7 days only

Tizanidine (e.g. Zanaflex)

Muscle relaxant

2mg starting dose TID

Increase gradually, if needed, to maximum 12mg TID

2^nd line

Hypotension (20% drop in blood pressure)

Limit use to 7 days

Methocarbamol (e.g. Robax Platinum, Robaxacet)

Muscle relaxant

1 to 2 tablets TID

2^nd line

Less drowsiness than cyclobenzaprine

Discolored urine (brown or green)

Gabapentin (e.g. Neurontin)

300 – 600mg TID

2^nd line

For sciatica related back pain

Drowsiness & fatigue

Tramadol (e.g. Zytram XL, Tramacet) or short-acting opioid (e.g. Oxycodone)

Tramacet 1-2 tabs QID

Xytram XL 150 to 400mg daily

Oxycoet 1 tab q6h

3^rd line

For pain not controlled by acetaminophen or NSAID

No more effective than NSAID for low back pain

Avoid tramadol if history of seizures or on SSRI

Use only 1 to 2 weeks