Exploring NSAIDs, Acetaminophens, and Antidepressants
If you suffer from any form of BACK PAIN, you know (or maybe you don’t) there are numerous options to help relieve your back pain. These options are placed in one of these categories:
Medications – Injections – High-Tech Treatments – Surgery
Because the research on these different options is extensive, I plan to cover each category over the next six to eight posts. Today, I’ll begin the first part of MEDICATIONS by talking about the first two categories: NSAIDs & Acetaminophens, and Antidepressants. These medications are used for treating pain and chronic pain in the back and other parts of the body.
This category appears to have the highest percentage of usage for treating back pain –temporary or chronic. I found five categories of medications:
1) NSAIDs and Acetaminophen,
3) Anti-seizure or (Anticonvulsants),
4) Muscle Relaxers, and
NSAIDs or Nonsteroidal Anti-inflammatory Drugs encompass a wide variety of medications that may be found OTC (over-the-counter) or may need a prescription from your doctor. In either form use caution when taking anti-inflammatory drugs. Be sure to administer the drug precisely as directed by your doctor and/or the package instructions.
There are numerous articles online for OTC Anti-Inflammatory medications and I urge you to surf the net for more information. I always look at the most recent article – try to avoid older articles because there is constant change in this industry. However, one site (Healthline.org) is beneficial and includes a guide to OTC Anti-Inflammatories.
This guide lists the common NSAIDs, how they help with pain, the side effects, and comments regarding drug interactions. Before using any of the medications listed in this post, please contact your doctor first. Your doctor needs to know your history and the drugs (you are presently taking) before deciding the best NSAID for you. Some drugs interaction with NSAIDs will make the NSAIDs less effective.
Note: If you’ve had chronic pain for more than six months, call your doctor’s office. Your pain may be chronic and this list of medicines may not be suggested by your doctor.
In the Guide to OTC Anti-Inflammatories … Aspirin (Bayer, St. Joseph), ibuprofen (Advil, Motrin, Midol) and naproxen (Aleve, Naprosyn) were noted as common NSAIDs.
ACETAMINOPHEN (Tylenol) is one of the most common pain medicines used for fever reduction and pain.
Acetaminophens are used for arthritis pain, common aches, or headaches. These drugs have good results except in the cases of pain lasting more than six months. If this is the case you may have ‘chronic’ pain and require a prescription for a stronger pain reliever. Check with your healthcare provider for more information.
Keep in mind acetaminophens do not reduce inflammation.
In the world of searching for drugs to help alleviate chronic pain, some drugs developed for other diseases have become the most effective and commonly used ways to treat chronic pain.
Case in point: antidepressants, which were developed for the treatment of depression. And although depression may not be a condition of the patient, antidepressants have become a pillar in the treatment of chronic pain conditions. Although it isn’t understood the connection between antidepressants and their treatment of pain; it is believed neurotransmitters in the spinal cord are increased by antidepressants which would reduce pain signals.
This type of medication must be taken daily – regardless of a low or non-existent pain level. And the relief isn’t experienced immediately. It can take several weeks to feel the effects of an antidepressant. Moderate relief has been reported by most patients who take antidepressants. If this medicine does not effectively lower your pain, your doctor may pair your antidepressant with an anticonvulsant.
There are three groups of antidepressants due to how they work and their chemical structure. Considered one of the most effective group for pain relief is the tricyclics.
A few Tricyclic Antidepressants (TCAs¹):
Side effects include:
Blurred vision, drowsiness, dry mouth, lightheadedness upon standing up (due to drop in blood pressure), weight gain, constipation, heart-rhythm, difficulty urinating, and difficulty thinking clearly.
To help prevent or reduce these side effects, you will begin with a lower dose and your healthcare provider will increase the dosage as needed. Ironically, the lower doses tend to be more effective for pain than the doses used for depression.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second group of antidepressants. Often, patients with chronic pain will develop depression. Drugs in this group help treat depression at the same dosages used for treating chronic pain.
Medicines in this group include duloxetine (Cymbalta), venlafaxine (Effexor), and milnacipran (Savella). Side effects are drowsiness, insomnia, nausea, dry mouth or elevated blood pressure. If your doctor suggests one of these medications, be sure to check the specific side effects by searching the drug online.
The third group of antidepressants, Selective serotonin reuptake inhibitors (SSRIs), include the drugs paroxetine (Paxil) and fluoxetine (Sarafem, Prozac). As medications for treating depression with chronic pain, these medications work well. However, they do not relieve pain on their own. Fluoxetine may be prescribed along with other tricyclic antidepressants to boost their painkilling agents.
Then there are antidepressants that are considered “atypical antidepressants” because they don’t fit into their own category. Atypical antidepressants are bupropion, trazodone, and mirtazapine.
Like most antidepressants, the side effects of atypical antidepressants include nausea, fatigue, dry mouth, diarrhea, nervousness, and headaches. Again, ask your healthcare provider questions about these drugs and their side effects. You can also go online and read reviews by patients who have taken or are taking these drugs.
(Please note: Slightly increased risk of suicidal thoughts or actions are associated with antidepressant medications. Please talk to your doctor before accepting these medications if you have entertained suicidal thoughts.)
[¹] Published April 13, 2016. Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ.