Back Pain and Drug Interactions: What You Need to Know

Gain knowledge and talk with your doctor about potential interactions.

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You may come to a point with your chronic back pain when stretching, ice, and rest simply don’t cut it. Although these alternative methods are tried and true, your spine specialist may also recommend pain medication, either daily or as needed. These pain medications can either be over-the-counter, or, if you need something stronger, can be prescribed by your doctor.

back pain drug interactionsMedications can be helpful for back pain, but be aware of how they interact with other meds you're taking or conditions you have.

It’s no wonder that pain medication has become more prevalent. About one in five U.S. adults struggle with chronic pain, according to the Centers of Disease Control and Prevention.

When You Might Need Prescription Medicine for Back Pain

Ai Mukai, MD, a physiatrist specializing at Texas Orthopedics Sports and Rehabilitation in Austin, Texas, believes that back pain patients reach a certain point when prescription medication could be helpful.

“Typically, prescription medication is used if the patient is in severe pain that has not responded to over-the-counter medications,” she says. “Acute inflammation responds pretty quickly to medications and sometimes ‘nipping it in the bud’ is easier than trying to control it once it’s really flared up.”

Anti-inflammatory medications, oral steroids, muscle relaxers, and nerve pain medications can give people with back pain a new lease on life. But there’s a flipside to consider if you’re about to or currently taking pain meds: These medications can interact with many other medications out there.

Here‘s what to keep in mind if you’re taking back pain medication.  

Muscle Relaxers and Antidepressants

In 2017, the American Psychological Association reported that 12.7% of Americans over the age of 12 had taken antidepressant medications within the previous month. It also stated that there’s been a 64% increase in people taking antidepressants between 1999 and 2014. Considering the prevalence of antidepressant use, here’s something to keep in mind if you’re also currently taking a muscle relaxer for your back pain.

“Muscle relaxers, especially those that resemble a class of medication called tricyclic anti-depressants, can interact with anti-depressants and cause dizziness and in rare cases something called serotonin syndrome,” explains Dr. Mukai.

According to Mayo Clinic, serotonin syndrome can happen when medications cause heightened levels of serotonin to accumulate in the body, resulting in confusion and rapid heart rate among other symptoms.

Dr. Mukai adds, “Another pain medication, called Tramadol, can also interact with certain anti-depressants and put people at risk for possible serotonin syndrome.”

Pain Medications and Antiseizure Medications  

Interactions can potentially take place if you unknowingly take two medications from similar classes—as it turns out, some pain medications and anti-seizure medications (anticonvulsants) are comparable or even the same.

Dr. Mukai says, “Anti-seizure medications can interact with nerve pain medications as many nerve pain medications are anti-seizure medications.”

Pain Medications and Health Issues

Sometimes, medications don’t necessarily interact with other medications—they interact with certain pre-existing health conditions.

“Anti-inflammatory medications, or NSAIDs, can cause stomach, kidney, and heart issues, so we generally won’t prescribe it for people with those issues,” Dr. Mukai notes. “Steroids can reduce your immune response and can also cause or worsen stomach ulcers. Anything with Tylenol or acetaminophen in it shouldn’t be used in patients with liver disease.”

A Team Effort

When it comes to being informed about interactions, naturally, there’s no one better to rely on for dependable information than your doctor.

Dr. Mukai has tips on how you and your doctor can work together effectively as you navigate medication options.

She advises, “Know what medications you are on and bring that list with you to doctor visits and make sure we have an updated list every visit.”

A pharmacist can be an ally as well. “Talk to your pharmacist when picking up new medications about potential side effects and interactions,” says Dr. Mukai. “Use one pharmacy consistently and try not to use different pharmacies for different medications so that the pharmacists know your entire medication list.”

back pain drug interactions pharmacistYour pharmacist is an ally and a resource.

Finally, it’s important to acknowledge that all medications, including over-the-counter meds and supplements, have side effects “and can impact your kidney, liver, and stomach,” Dr. Mukai says.

“The less, the better when it comes to medications,” she shares. “Being up front about what medications you are on helps us physicians make the best decisions for you. I have had times where I couldn’t safely prescribe any medications because the patient didn’t bring their medication list. Also, let the doctor know if you have tried prescription medications in the past and whether they worked or caused side effects. How people react to medications is very variable, and we think probably has something to do with genetics, so it’s helpful to know if you tend to be sensitive to medications.”

The bottom line is this: Ask questions about potential interactions, readily share the medications you’re currently on with your doctor and pharmacist, and always err on the side of caution if you choose to start taking pain medication.

Updated on: 06/05/20
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