![]() For example, if an anesthetic is injected into the wrong place it can cause respiratory paralysis, making it hard to breathe. There is no good-quality research on the effectiveness of the various kinds of injections in the treatment of non-specific low back pain. Although side effects are rare, they can lead to serious complications. Different drugs are injected into different places: for instance, into muscle tissue, into the tissue directly surrounding nerves, ligaments or spinal disks, into the joints of the spine, or into a space in the spinal canal known as the epidural space. Some of these medications aim to stimulate the body’s natural healing processes if the problem is being caused by irritated nerve roots, tendons and ligaments, or to reduce inflammation or numb the pain. If you use opioids, it can be a good idea to seek advice from a pain specialist who has a lot of experience with these drugs. Opioids generally shouldn't be used for longer than 12 weeks. Treatment with opioids is an option if other treatments haven't helped enough or if NSAIDs can't be used. According to studies in this area, it is estimated that this happens to about 6% of all people who use opioids over a long period of time. People can become physically dependent on opioids too. This is also true for skin patches containing opioids (e.g. ![]() So it is very important to follow the doctor's instructions and not to increase the dose without talking to the doctor first. There is also a small risk of a life-threatening overdose. ![]() Opioids can have side effects such as constipation, nausea, decreased sex drive, dizziness and tiredness, affecting your ability to drive vehicles. They usually don't work any better than NSAIDs do. In studies, opioids were shown to relieve the pain in only about 10 out of 100 people. But they aren't as good at relieving low back pain as commonly believed. Opioids are very effective at relieving many different types of acute pain. Morphine, for example, is a very strong opioid, while tramadol is a weaker one. Other opioids include buprenorphine, codeine, hydromorphone, oxycodone, tapentadol, tilidine and tramadol. If other treatments don't work well enough, low back pain can be treated with stronger, prescription-only painkillers known as opioids. These medications are not approved for the treatment of back pain, so they are only rarely used – for instance, if opioids are the only other option. Two other anti-inflammatory painkillers that have a similar effect are two COX-2 inhibitors called celecoxib and etoricoxib (also referred to as coxibs). Because of the possible side effects, it's a good idea to carefully consider the pros and cons of the medications, make sure you don't take them for too long, and use them correctly. People who have kidney failure should talk to their doctor before taking NSAIDs. They also slightly increase the risk of developing certain heart problems. NSAIDs can cause stomach ache and – if taken over long periods of time – increase the likelihood of developing a stomach ulcer. In rare cases they can also lead to serious complications such as abscesses or nerve damage. Injections aren't recommended nowadays, though, because they can cause bleeding or inflammation where the needle enters the skin. NSAIDs can be taken as tablets or injected into muscle tissue. Lower doses of these drugs are available without a prescription. They can often relieve the symptoms a little. Non-steroidal anti-inflammatory drugs (NSAIDS) such as diclofenac, ibuprofen and naproxen are the most commonly used medications for low back pain. What's more, painkillers only have a limited effect in the treatment of non-specific low back pain. Because medication can have side effects – especially when taken over longer periods of time – it shouldn't be taken continuously, but rather only for a short while, for example when the pain is especially severe. The medications used include over-the-counter and prescription painkillers, muscle relaxants and antidepressants. Staying active and moving enough are among the most effective things you can do yourself. Good-quality studies have so far found that only few treatments help. If low back pain lasts a long time or keeps returning, it is often difficult to treat. It is then called "non-specific" back pain. In most cases it's not clear what's causing the pain. Low back pain usually goes away on its own after a while. Because of the associated risks, though, they shouldn't be used over a long period of time. Painkillers are only recommended in addition to active treatments such as exercises and movement – for example, to relieve severe back pain or to help you start moving more again.
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