Pain Medications for Degenerative Disc Disease Treatment

There are multiple medications that may readily relieve low back pain associated with degenerative disc disease. Some of these medications may be used in combination with each other. Pain medication is typically recommended alongside a prescribed exercise program and a range of self-care activities, to rehabilitate the back.

Medications may be available with or without a prescription, and some are available in forms such as a cream or an injection.

Over-The-Counter Medicine for Low Back Pain

The standard first-line treatment for lower back pain is over-the-counter pain medications,¹Peck J, Urits I, Peoples S, et al. A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain [published online ahead of print, 2020 Nov 4]. Pain Ther. 2020;10.1007/s40122-020-00209-w. doi:10.1007/s40122-020-00209-w such as acetaminophen, ibuprofen, and naproxen. Applying a topical cream or a heat wrap may also be useful remedies that do not require a prescription.²Nadler SF, Steiner DJ, Erasala GN, Hengehold DA, Abeln SB, Weingand KW. Continuous low-level heatwrap therapy for treating acute nonspecific low back pain. Arch Phys Med Rehabil. 2003;84(3):329-334. doi:10.1053/apmr.2003.50102^,3Nadler SF, Steiner DJ, Petty SR, Erasala GN, Hengehold DA, Weingand KW. Overnight use of continuous low-level heatwrap therapy for relief of low back pain. Arch Phys Med Rehabil. 2003;84(3):335-342. doi:10.1053/apmr.2003.50103^,4Ginsberg F, Famaey JP. A double-blind study of topical massage with Rado-Salil ointment in mechanical low-back pain. J Int Med Res. 1987;15(3):148-153. doi:10.1177/030006058701500304^,5Gaubitz M, Schiffer T, Holm C, Richter E, Pisternick-Ruf W, Weiser T. Efficacy and safety of nicoboxil/nonivamide ointment for the treatment of acute pain in the low back - A randomized, controlled trial. Eur J Pain. 2016;20(2):263-273. doi:10.1002/ejp.719

As with all medications, over-the-counter medications carry potential risks and side effects, some of which may be serious. These medications are meant to be taken only as indicated and with a physician’s guidance.

Acetaminophen

Acetaminophen (such as Tylenol) is a pain medication that works by dampening the brain's perception of pain. Acetaminophen does not treat the underlying sources of pain, such as inflammation from a degenerated disc.

Acetaminophen is a first-line recommendation as a relatively safe and effective pain reliever for occasional painful flare-ups in the lower back. Continuous use of acetaminophen in large doses may have potential risks and side effects, such as slightly increased blood pressure and increased risk of bleeding in the gut, as well as other risks.⁶McCrae JC, Morrison EE, MacIntyre IM, Dear JW, Webb DJ. Long-term adverse effects of paracetamol - a review. Br J Clin Pharmacol. 2018;84(10):2218-2230. doi:10.1111/bcp.13656

See Acetaminophen Potential Risks and Complications

NSAIDs

NSAIDs, or non-steroidal anti-inflammatory drugs, are a large class of pain medications that work by reducing the inflammation that is associated with painful degenerative disc disease. Certain NSAIDs require a prescription while others do not.

Over-the-counter NSAIDs most commonly used to treat low back pain from degenerative disc disease include:

• Ibuprofen (such as Advil, Motrin)
• Naproxen (such as Aleve, Naprosyn)

Regular use of NSAIDs in the recommended doses allows the drug to accumulate in the body, providing an anti-inflammatory effect and a better healing environment for the low back. NSAIDs are less effective if taken only at the onset of low back pain.

NSAIDs and acetaminophen may be combined for greater overall pain relief than either drug alone. Doctors may recommend this combination of drugs to address both the pain and underlying inflammation, after considering the expected duration of pain and the risk of side effects.

See Potential Risks and Complications of NSAIDs

Herbal creams and supplements

Alternative treatments are commonly sought-after for back pain, particularly due to the risk of side effects and sometimes highly addictive properties of certain medications.

Several herbal remedies and supplements may include⁸Gagnier JJ, Oltean H, van Tulder MW, Berman BM, Bombardier C, Robbins CB. Herbal Medicine for Low Back Pain: A Cochrane Review. Spine (Phila Pa 1976). 2016;41(2):116-133. doi:10.1097/BRS.0000000000001310:

• Capsaicin (capsicum) creams or balms,⁵Gaubitz M, Schiffer T, Holm C, Richter E, Pisternick-Ruf W, Weiser T. Efficacy and safety of nicoboxil/nonivamide ointment for the treatment of acute pain in the low back - A randomized, controlled trial. Eur J Pain. 2016;20(2):263-273. doi:10.1002/ejp.719^,9Blahova Z, Holm JC, Weiser T, Richter E, Trampisch M, Akarachkova E. Nicoboxil/nonivamide cream effectively and safely reduces acute nonspecific low back pain - a randomized, placebo-controlled trial. J Pain Res. 2016;9:1221-1230. Published 2016 Dec 14. doi:10.2147/JPR.S118329 such as tiger balm. The main chemical is derived from chili peppers.
• Harpagoside (devil’s claw) supplements. This herb comes from southern Africa.
• Salicin creams or supplements. This chemical comes from white willow bark.
• Comfrey creams. Comfrey is obtained from the roots of a flowering plant.
• Lavender essential oil. Applying the oil with acupressure may be effective.¹⁰Yip YB, Tse SH. The effectiveness of relaxation acupoint stimulation and acupressure with aromatic lavender essential oil for non-specific low back pain in Hong Kong: a randomised controlled trial. Complement Ther Med. 2004;12(1):28-37. doi:10.1016/j.ctim.2003.12.003

All herbal creams and supplements are intended for short-term pain relief, and physicians need to be made aware of the herbal treatments that are used. Not all over-the-counter creams are considered safe for all people. For example, topical comfrey products may be harmful if used on ruptured skin, in large amounts, or for longer than 10 days.

Prescription Medications for Degenerative Disc Disease

Continuous pain from a degenerating disc, or severe pain, may be treated with prescription pain medications. Most of the medications are used as short-term treatments, to help reduce pain and facilitate physical therapy and exercise. The most commonly prescribed pain medicines for degenerative disc disease include the following:

• Oral steroids are powerful anti-inflammatory medications that may be an effective treatment for low back pain from degenerative disc disease. Typically, oral steroids are prescribed in a Medrol Dose Pack, starting with a high dose to provide initial low back pain relief, then tapering down to a lower dose over 5 or 6 days. Due to several possible complications, steroid use is limited to treating flare-ups of severe pain for only 1 to 2 weeks.
• Narcotic pain medications, such as codeine (Tylenol #3), hydrocodone (Vicodin), and oxycodone (Percocet or Oxycontin), work by having a dissociative effect that helps pain management. Narcotic pain medications are generally used only for severe episodes of low back pain on a short-term basis, as they are potentially addictive. Tolerance to narcotics may develop quickly, over 1 or 2 weeks.
• Prescription-strength NSAIDs, such as diclofenac (Voltaren) or celecoxib (Celebrex), work by blocking the inflammation-promoting enzyme COX-2. While celecoxib, a COX-2 inhibitor, may have fewer risks than over-the-counter NSAIDs,¹¹Solomon DH, Husni ME, Libby PA, et al. The Risk of Major NSAID Toxicity with Celecoxib, Ibuprofen, or Naproxen: A Secondary Analysis of the PRECISION Trial. Am J Med. 2017;130(12):1415-1422.e4. doi:10.1016/j.amjmed.2017.06.028 the COX-2 inhibitors are used in low doses on a short-term basis, to avoid more serious health risks such as heart attack or stroke.
• Muscle relaxants such as carisoprodol (Soma), cyclobenzaprine (Flexeril), and diazepam (Valium) work by having an overall sedative effect on the body. Typically, muscle relaxants are prescribed early in a course of low back pain to alleviate pain caused by muscle spasms. This class of drugs is generally prescribed for short-term use only, because continued use may quickly lead to tolerance and dependence, even at low doses.¹²Lader M. Benzodiazepine harm: how can it be reduced?. Br J Clin Pharmacol. 2014;77(2):295-301. doi:10.1111/j.1365-2125.2012.04418.x^,13Bateson AN. Basic pharmacologic mechanisms involved in benzodiazepine tolerance and withdrawal. Curr Pharm Des. 2002;8(1):5-21. doi:10.2174/1381612023396681

  See Side Effects and Risks of Muscle Relaxers

• Tramadol, a narcotic medication, works in the brain and does not have any anti-inflammatory effects. Tramadol may be taken with anti-inflammatory pills or with acetaminophen (Tylenol). Ultracet is the brand name of a pain medication that includes both tramadol and acetaminophen, so Ultracet should not be combined with additional acetaminophen.
• Anti-seizure medications, such as gabapentin (Neurontin), are sometimes prescribed to help control chronic low back pain. They may be especially useful for nerve pain, such as sciatica or peripheral neuropathy, caused by the degenerated disc. The use of anti-seizure medications is typically suitable for long-term relief of chronic pain, as the drugs are generally well tolerated.

Read more about Medications for Back Pain and Neck Pain

All medications, including non-prescription (over-the-counter) drugs, are meant to be taken under a physician's supervision.

Most pain medications require caution and consideration of potential side effects. For example, acetaminophen is not recommended for individuals with liver disease, and ibuprofen is not recommended for women who breastfeed.