Back Pain – Medications to Try Before an MRI

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Are you one of the 65 million Americans who suffer from back pain? No doubt you’d like the instant cure – if there were one. Unfortunately, none exists.

Although medication is not the only treatment option, it is probably the most common – and usually the least expensive. Certainly heat, ice, massage, weight loss, exercise, and physical therapy are useful modalities. They are all worth trying before resorting to a $3,000 MRI.

But for quick relief, what drugs work the best, cost the least, and have the fewest side-effects?

Classes of medications that are commonly used to treat back pain include: anti-inflammatory drugs, muscle relaxers, pain medications, and topical treatments.

Of the anti-inflammatory drugs, there’s the non-steroidal group (NSAIDs) and the steroidal group. The NSAIDs work well, and can be used chronically or as needed.

The most common side-effect of NSAIDs is stomach irritation. Because of this potential, Celebrex was developed, an NSAID-like cox-2 inhibitor that is less likely to bother the stomach or colon. But it is expensive. Self-pay patients can expect to pay about $137 for a month’s supply of 200 mg, or $85 for 100 mg at a discount pharmacy. If your income is below $45,000 and you are not a Medicare patient, you may qualify for the Together Rx Access program for discounted drugs, available online or through your physician. You can also check online for coupons to offset your cost or your co-pay. If you have insurance, this drug is likely to be a 2nd or 3rd tier, requiring a higher co-pay than generic drugs.

But most patients do not have sufficient stomach irritation to warrant the use of Celebrex. If you do have a problem taking anti-inflammatory drugs, a second option is to use a medication to lower your stomach acid (for example, generic Pepcid for $4), which may allow you to use a $4 NSAID. Some of these are over-the-counter, but it’s important that you consult your doctor with questions of drug interactions and other side-effects.

One list of $4 generic NSAIDs includes: diclofenac, ibuprofen, naproxen, indomethacin, meloxicam, and piroxicam. Check with your local pharmacy and take their $4 list with you to your doctor. Over-the-counter NSAIDs include ibuprofen, naproxen, and aspirin. These are lower dose than prescription NSAIDs, but often all a person needs to recover from a strained back.

The Wal-Mart $4 list also includes prednisone, dexamethasone, and methylprednisolone, three steroids that can be used in an acute situation.

Of the muscle relaxers, baclofen and cyclobenzaprine are quite inexpensive, often under $5. These are especially useful when your back muscles are tight, or if you cannot sleep. Drowsiness is the most common side-effect. Skelaxin currently comes only as a brand-name, and costs 20 times as much – or more! Currently, Skelaxin offers a printable coupon at the manufacturer’s website.

Straight pain medications are also useful. Tylenol (acetaminophen) provides sufficient relief for many people. It can often be used with an NSAID – but consult your doctor first. Excedrin is an example of a single pill that includes both acetaminophen and an anti-inflammatory (aspirin).

The non-narcotic drug tramadol (generic Ultram) is quite inexpensive (on some $4 lists) and is very effective.

Topical preparations such as the Flector patch or creams such as Voltaren Gel are also effective but expensive. If your doctor prescribes these, check online for a coupon. I’ve had patients who’ve found topical creams at the dollar stores that they claim work just as well. If it works for you, go for it.

If none of these choices are effective for you, perhaps you require a short-term narcotic. Any back strain that persists beyond a week or so, especially if it’s getting worse, should be evaluated by a physician.

Should you get an MRI? Only if your doctor believes your pain is atypical, or if it’s getting worse, or if you can’t use your legs properly. An MRI doesn’t fix anything. It can show a slipped disc, or spinal stenosis, or cancer, or infections. But for the average Joe or weekend warrior who overdid it moving furniture, no x-rays are generally needed. If your doctor orders a CAT scan or MRI right off the bat, ask why, and whether a round of conservative therapy might not be appropriate first.

Copyright 2010 Cynthia J. Koelker, M.D.

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