[Back pain: guidelines for drug therapy. Utilize the therapeutic spectrum]

For the treatment of back pain, behavioral modification, pharmacotherapy, non-pharmacological conservative treatment and surgical procedures are available. Systemic and metabolic disorders require specific treatment. Medication that may be considered includes non-opioid analgesics with or without an antiphlogistic action, opioid analgesics, muscle relaxants and antidepressants. The choice of substance(s) will depend on the pathophysiology and the duration of the pain condition. In the case of acute pain with an inflammatory component, NSAIDs are the drugs of first choice. However, prolonged administration carries a risk of gastrointestinal and renal complications. Muscle relaxants may be useful adjuvants for a limited time. For myofascial pain, flupirtine is to be recommended because of its analgetic and muscle-tone-normalizing actions. Local anesthetic infiltration or nerve blocks are useful in blocking nociception with its pathophysiological sequelae. For chronic back pain, opioids and some antidepressants have a more favorable benefit-risk profile than NSAIDs.