Do pills help back pain / sciatica?

Did I pop pills when my back pain / sciatica was at its worst?  You bet.  But before we get into that, here’s a little formality…

If your doctor has prescribed medication for your pain, please don’t stop taking it without discussing this with him/her.

Now, there are two sides to every story aren’t there?  I posted previously on a recent study on paracetamol for lower back pain.  So, the science behind medication for back pain and sciatica is still evolving.  But, based on current clinical guidelines issued by the UK National Institute for Health and Care Excellence (Scotland doesn’t have a specific guideline on lower back pain), there is a role for painkillers, anti-inflammatories, opioid drugs, and other medications such as anti-depressants (in lower doses than you’d have for depression), anti-convulsants  (same) and muscle relaxants.  I meet back pain and sciatica sufferers who are taking paracetamol, an anti-inflammatory, tramadol (an opiate), an anti-convulsant drug and an anti-depressant.   Are they spaced out, not sure what’s helping if at all?  Nearly always. 🙁

The Pros

Let’s be clear – medication doesn’t cure your back problem.  But what it can do is to help you sleep and move more easily.  Sleep and movement are really important to healing.  The other benefit to dulling your pain is that it decreases the likelihood of your central nervous system becoming sensitised – which can lead to chronic pain.

And, apart from that, medication can just make life a lot more tolerable.

The Cons

Side effects are the obvious con – especially with the opiates, anti-seizures and anti-depressants.  I’m not going to list all the potential side effects here, but you may feel that the side effects outweigh the benefits.  If you’re taking a cocktail of these drugs – and especially if you\’re over 60ish – the potential for just feeling wiped out or weird on some level is pretty high.

People often ask “Will I do myself more harm if I can’t feel the pain?”, suggesting that by masking the pain you will in fact be aggravating the underlying problem.  I would say that’s possible, but just remember what hurt before you took the pills and try not to get carried away with those activities.  A classic is that widely-used, non-prescription recreational drug… alcohol.  Sitting having a glass or two of red wine on a Friday evening, your back pain may not be noticeable.  But come the next morning the back pain may be back with a vengeance; especially if sitting tends to aggravate your pain.  So, the wine dulled the pain allowing you to sit without pain, but the sitting aggravated the problem at source, so when the wine wears off… the back pain is worse.

The takeaway message…

Use medication as part of your overall plan to get better.  Don’t expect it to “cure” your problem.  Find out what the underlying cause is and address that, while the pills buy you a bit of relief, sleep and more movement.

Just as a little aside, I was talking to an Edinburgh GP the other week and he was expressing great concern over the number of lower back pain sufferers “stuck” on opioid drugs.  The British Medical Association and other national medical associations are very concerned that these drugs have a big negative impact on people in the long-term.  So discuss any opioid usage with your doctor, and express your desire NOT to become a long-term user.

If you’d like more specific advice on how to get a better back or less sciatica, please just get in touch.



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