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Back Pain – Medications to Try Before an MRI

Are you one of the 65 million Americans who suffer from back pain? No doubt you want instant therapy – if it’s available. Unfortunately, there isn’t.

Although medication is not the only treatment option, it can be the most common – and often the most expensive. Heat, ice, massage, weight loss, exercise, and physical therapy are certainly beneficial methods. All of them are worth trying before committing to a $3,000 MRI.

But for quick relief, what is the best, cheapest and least effective medicine?

Classes of drugs used for back pain include: anti-inflammatory drugs, muscle relaxants, pain relievers, and headache medications.

Among the anti-inflammatory drugs, there is the non-steroidal group (NSAIDs) and the steroidal group. NSAIDs work well, and can be used long-term or as needed.

The most common side effect of NSAIDs is stomach upset. Because of this power, Celebrex was developed, a cox-2 inhibitor similar to an NSAID that is less irritating to the stomach or colon. But it is expensive. Self-pay patients can expect to pay about $137 for a one-month supply of 200 mg, or $85 for 100 mg at a discount pharmacy. If your income is less than $45,000 and you are not a Medicare patient, you may be eligible for the Together Rx Access program for discounted drugs, available online or from your doctor. You can also check the ticket online to cover your fees or charges. If you have insurance, this drug may be level 2 or 3, requiring a higher payment than conventional drugs.

But most patients do not have stomach irritation to warrant the use of Celebrex. If you have problems taking anti-inflammatory drugs, the second option is to use drugs to reduce stomach acid (for example, generic Pepcid for $ 4), which may allow you to use NSAIDs $ 4. Some of them is unacceptable, but it is important to consult a doctor with questions about drug interactions and other side effects.

The list of $4 generic NSAIDs includes: diclofenac, ibuprofen, naproxen, indomethacin, meloxicam, and piroxicam. Check with your local pharmacy and take the $4 list with you to the doctor. Over-the-counter NSAIDs include ibuprofen, naproxen, and aspirin. These are lower doses than prescription NSAIDs, but usually all people need to recover from severe back pain.

Wal-Mart’s $4 list includes prednisone, dexamethasone, and methylprednisolone, three steroids that can be used in severe cases.

For muscle relaxants, baclofen and cyclobenzaprine are inexpensive, usually less than $5. These are useful when your back muscles are tight, or if you can’t sleep. Drowsiness is the most common side effect. Skelaxin is currently only available as a brand name, and costs 20 times the price – or more! Currently, Skelaxin offers printable coupons on the manufacturer’s website.

Over the counter pain relievers are also helpful. Tylenol (acetaminophen) provides enough relief for many people. It can often be used in combination with NSAIDs – but check with your doctor first. Excedrin is an example of a single pill that contains acetaminophen and an anti-inflammatory (aspirin).

The non-narcotic drug tramadol (Ultram generic) is inexpensive (at $4 list) and very effective.

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

If none of these options work for you, you may need a long-term drug. Back pain that lasts more than a week or more, especially if it gets worse, should be checked by a doctor.

Should you have an MRI? If your doctor doesn’t believe your pain is unusual, or if it gets worse, or if you can’t use your leg properly. An MRI doesn’t fix anything. It may indicate a slipped disc, spinal stenosis, cancer, or disease. But for the average Joe or weekend warrior who does more than just move furniture, x-rays aren’t necessary. If your doctor orders a CAT scan or MRI right away, ask why, and if traditional treatment may not work first.

Copyright 2010 Cynthia J. Koelker, MD

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