| Are you one of the 65 million Americans who suffer | | | | NSAIDs include ibuprofen, naproxen, and aspirin. These |
| from back pain? No doubt you'd like the instant cure - | | | | are lower dose than prescription NSAIDs, but often all |
| if there were one. Unfortunately, none exists. | | | | a person needs to recover from a strained back. |
| Although medication is not the only treatment option, it | | | | The Wal-Mart $4 list also includes prednisone, |
| is probably the most common - and usually the least | | | | dexamethasone, and methylprednisolone, three |
| expensive. Certainly heat, ice, massage, weight loss, | | | | steroids that can be used in an acute situation. |
| exercise, and physical therapy are useful modalities. | | | | Of the muscle relaxers, baclofen and cyclobenzaprine |
| They are all worth trying before resorting to a $3,000 | | | | are quite inexpensive, often under $5. These are |
| MRI. | | | | especially useful when your back muscles are tight, or |
| But for quick relief, what drugs work the best, cost the | | | | if you cannot sleep. Drowsiness is the most common |
| least, and have the fewest side-effects? | | | | side-effect. Skelaxin currently comes only as a |
| Classes of medications that are commonly used to | | | | brand-name, and costs 20 times as much - or more! |
| treat back pain include: anti-inflammatory drugs, muscle | | | | Currently, Skelaxin offers a printable coupon at the |
| relaxers, pain medications, and topical treatments. | | | | manufacturer's website. |
| Of the anti-inflammatory drugs, there's the | | | | Straight pain medications are also useful. Tylenol |
| non-steroidal group (NSAIDs) and the steroidal group. | | | | (acetaminophen) provides sufficient relief for many |
| The NSAIDs work well, and can be used chronically or | | | | people. It can often be used with an NSAID - but |
| as needed. | | | | consult your doctor first. Excedrin is an example of a |
| The most common side-effect of NSAIDs is stomach | | | | single pill that includes both acetaminophen and an |
| irritation. Because of this potential, Celebrex was | | | | anti-inflammatory (aspirin). |
| developed, an NSAID-like cox-2 inhibitor that is less | | | | The non-narcotic drug tramadol (generic Ultram) is |
| likely to bother the stomach or colon. But it is | | | | quite inexpensive (on some $4 lists) and is very |
| expensive. Self-pay patients can expect to pay about | | | | effective. |
| $137 for a month's supply of 200 mg, or $85 for 100 | | | | Topical preparations such as the Flector patch or |
| mg at a discount pharmacy. If your income is below | | | | creams such as Voltaren Gel are also effective but |
| $45,000 and you are not a Medicare patient, you may | | | | expensive. If your doctor prescribes these, check |
| qualify for the Together Rx Access program for | | | | online for a coupon. I've had patients who've found |
| discounted drugs, available online or through your | | | | topical creams at the dollar stores that they claim |
| physician. You can also check online for coupons to | | | | work just as well. If it works for you, go for it. |
| offset your cost or your co-pay. If you have insurance, | | | | If none of these choices are effective for you, |
| this drug is likely to be a 2nd or 3rd tier, requiring a | | | | perhaps you require a short-term narcotic. Any back |
| higher co-pay than generic drugs. | | | | strain that persists beyond a week or so, especially if |
| But most patients do not have sufficient stomach | | | | it's getting worse, should be evaluated by a physician. |
| irritation to warrant the use of Celebrex. If you do | | | | Should you get an MRI? Only if your doctor believes |
| have a problem taking anti-inflammatory drugs, a | | | | your pain is atypical, or if it's getting worse, or if you |
| second option is to use a medication to lower your | | | | can't use your legs properly. An MRI doesn't fix |
| stomach acid (for example, generic Pepcid for $4), | | | | anything. It can show a slipped disc, or spinal stenosis, |
| which may allow you to use a $4 NSAID. Some of | | | | or cancer, or infections. But for the average Joe or |
| these are over-the-counter, but it's important that you | | | | weekend warrior who overdid it moving furniture, no |
| consult your doctor with questions of drug interactions | | | | x-rays are generally needed. If your doctor orders a |
| and other side-effects. | | | | CAT scan or MRI right off the bat, ask why, and |
| One list of $4 generic NSAIDs includes: diclofenac, | | | | whether a round of conservative therapy might not be |
| ibuprofen, naproxen, indomethacin, meloxicam, and | | | | appropriate first. |
| piroxicam. Check with your local pharmacy and take | | | | Copyright 2010 Cynthia J. Koelker, M.D. |
| their $4 list with you to your doctor. Over-the-counter | | | | |