Treatment Overview
Step 2: Medications
Medications play a supporting role — not the lead. Their purpose is to reduce pain enough so that you can participate in exercise and rehabilitation.
What the evidence says
| Medication | Evidence of Benefit | Important Considerations |
|---|---|---|
| Paracetamol (Acetaminophen) | Not effective for chronic low back pain (shown in high-quality research) | Widely used but does not help chronic back pain specifically |
| NSAIDs (Ibuprofen, Naproxen) | Small benefit | Risk of stomach, kidney, and cardiovascular problems — especially with long-term use or in older adults |
| Duloxetine (Cymbalta) | Moderate benefit | The only antidepressant with regulatory approval for chronic low back pain in several countries |
| Gabapentinoids (Pregabalin, Gabapentin) | May help neuropathic (nerve) pain | Dizziness and drowsiness are common side effects |
| Opioids | Small benefit at best | Not recommended for long-term use due to tolerance, dependence, and limited effectiveness over time |
A fact that surprises many people: Paracetamol (acetaminophen / Tylenol), one of the most commonly used painkillers, has been shown to be no more effective than placebo for chronic low back pain.
For more detail, see Medications for Chronic Low Back Pain.
A note on insurance coverage
Medication costs and coverage vary considerably depending on your country and insurance plan. In some countries (UK, Australia), many of these medications are subsidized through national health systems. In the United States, coverage depends on your specific insurance plan. Ask your pharmacist or insurer about out-of-pocket costs before starting a new medication.