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Review
. 2025 Apr 23;15(5):690.
doi: 10.3390/life15050690.

Pain Medication in Chronic Low Back Pain

Ali Jerjir  1 , Frederik Nietvelt  1 , Iris Smet  1 , Nina D'hondt  1 , Jean-Pierre Van Buyten  1
Affiliations
Review

Pain Medication in Chronic Low Back Pain

Ali Jerjir et al. Life (Basel). .

Abstract

Chronic low back pain (CLBP) significantly impacts individuals' quality of life and functional abilities. In non-oncological settings, CLBP is often treated for long periods using pharmacotherapy. This paper provides a comprehensive overview of pharmacological treatments for CLBP, detailing their mechanisms of action, adverse effects, and evidence supporting their use. We discuss various medication classes, including NSAIDs, acetaminophen, antidepressants, gabapentinoids, tramadol, major opioids, corticosteroids, antispasticity drugs, benzodiazepines, and antibiotics. Special emphasis is given to the opioid crisis, examining its history, the pathophysiology of opioid tolerance and dependence, the need for cautious opioid use, the key challenges in treatment and emerging medications for CLBP. We also share insights from our experiences with polypharmacy, commonly seen in CLBP patients, at a specialized pain centre in Belgium.

Keywords: CLBP; CPG; chronic low back pain; clinical patient guidelines; evidence-based management; opioid crisis; opioids; pharmacotherapy; polypharmacy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Global pain experienced is the sum of two ascending spinothalamic pathways minus the influence of the descending inhibitory pathway that must modulate these ascending pain pathways. Chronic opioid use underpins this inhibitory pathway, leading to an increase in pain experienced.
See this image and copyright information in PMC

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