According to the Cleveland Clinic, “Up to two-thirds of patients with chronic pain conditions suffer from sleep disorders.”
Prescription Medications for Back Pain and Sleep
The 9 Most Frequently Prescribed Sleeping Pills
Chart Caption: From Mayo Clinic
Depending on the type, people taking prescription sleeping pills may exhibit side effects, including:
- Dizziness or lightheadedness
- Gastrointestinal problems, including diarrhea and nausea
- Prolonged drowsiness
- Severe allergic reactions
- Sleep behaviors
- Problems with memory and performance during waking hours
Always speak with your doctor about the potential side effects before starting a sleeping pill regimen.
Prescription medicines for severe back pain include antidepressants. Sometimes prescription drugs used primarily to treat depression may ease insomnia when taken in low doses. Although widely used, these are not approved by the Food and Drug Administration (FDA) for insomnia only. When insomnia is secondary to depression or anxiety, antidepressants may work to relieve both conditions simultaneously.
Examples of prescription drugs that may reduce your back pain, headaches, nerve pain and fibromyalgia include:
- Mirtazapine (Remeron)
- Trazodone (Oleptro)
- Aventyl, Pamelor (nortriptyline)
- Desyrel (trazodone)
- Elavil (amitriptyline)
- Serzone (nefazodone)
- Cymbalta (duloxetine) — approved for musculoskeletal pain
Taking antidepressants can cause several possible side effects, including:
- Physical Symptoms. When you initiate an antidepressant treatment, depression medication, side effects may include physical symptoms such as a headache, joint pain, muscle aches, nausea, skin rashes, or diarrhea. These symptoms are usually mild and temporary.
- Sleep Disturbances. You may notice that you still have trouble sleeping when you first start taking an antidepressant. This is because your body may need time to get used to the effects it has on your brain. Other symptoms common with selective serotonin reuptake inhibitor (SSRIs) include nightmares and sleepwalking.
- Daytime Sleepiness. SSRI medication side effects may include daytime sleepiness and nighttime wakefulness. An estimated 25 percent of patients on SSRI drugs will experience one or both of these side effects.
- Migraines. Unfortunately, migraines tend to be more common in people with depression, so be extra careful when taking SSRIs. Medications used to treat migraines, triptans, and SSRIs increase the brain chemical serotonin. If taken together, these medications may cause serotonin syndrome, the symptoms of which may include flushing, rapid heart rate, or headaches.
Ask your doctor about potential side effects if you’re taking prescription medications for both sleep and back pain conditions.
Anti-anxiety medications can increase drowsiness and promote sleep. While these drugs may be useful short-term, all benzodiazepines — a class of anti-anxiety pills — are potentially addictive and may cause problems with memory and attention if used over an extended period of time. They are usually not recommended for long-term treatment of sleeping problems. Examples of Benzodiazepines include:
- Ativan (lorazepam)
- Dalmane (flurazepam)
- Klonopin (clonazepam)
- Restoril (temazepam)
- Valium (diazepam)
Halcion (triazolom) is an older benzodiazepine sedative-hypnotic medicine that has largely been replaced by newer medications like the ones above. Common side effects of benzodiazepines include:
- Poor balance or coordination
- Slurred speech
- Trouble concentrating
- Memory problems
- Upset stomach
- Blurred vision
A muscle relaxant helps to relieve pain stemming from muscle spasms while helping you sleep. Medical professionals do not advise their use for long-term pain relief. Side effects can include drowsiness, dry mouth, constipation, and confusion. Examples of muscle relaxants include:
- Flexeril (cyclobenzaprine)
- Lioresal (baclofen)
- Skelaxin (metaloxalone)
- Soma (carisoprodol)
Opioid Pain Kilers
Opioids help to treat acute to severe chronic back pain and may promote sleep. Some of these medicines can disrupt the natural sleep cycle, reducing the amount of deep sleep you get. You may feel tired and ready for bed. You may also fall asleep more easily, but the medication may prevent you from entering deep rapid eye movement (REM) sleep. Other side effects of opioids include nausea, constipation, and risk of addiction.
Examples of opioids include:
- OxyContin (oxycodone)
- Percocet (oxycodone with acetaminophen)
- Vicodin (hydrocodone with acetaminophen
While opioids require a prescription, other drugs that can be used to manage back pain and insomnia do not.
Non-Steroidal Anti-Inflammatory Drugs (NSAID)
These products may be effective for short-term use to relieve your back pain. They may also cause liver toxicity in high doses, so be careful when taking them long-term. While there is no exact match for Ambien in over-the-counter form, several other sleep aids are available without a prescription.
Most sleep aids include antihistamines, an ingredient found in cold medicines that may also work as a sedative. One powerful antihistamine is Benadryl, an allergy medication. Others include:
Over-the-Counter Sleep Aids with Pain Relief Properties
Like the NSAIDs, these drugs may help you sleep by including an antihistamine. However, according to the National Institutes of Health, the effectiveness of antihistamines as a sleep aid is not well established and they can have side effects like daytime drowsiness and decreased cognitive function.
Use these drugs only as directed and let your doctor know what you are taking so they may approve before you consume. Examples include:
- Advil PM (ibuprofen and diphenhydramine)
- Tylenol PM (acetaminophen and diphenhydramine)
- Aleve PM (naproxen sodium and diphenhydramine HCl)
According to the Mayo Clinic, “Tolerance to the sedative effects of antihistamines can develop quickly — so the longer you take them, the less likely they are to make you sleepy.” Side effects of over-the-counter medications include:
- Skin rash
- Daytime drowsiness
Medications should only be used for as long as your medical team recommends. Long-term use can result in dependence on the various drugs discussed above and can eventually throw your body's natural alarm clock more out of whack than it already is. The goal is to help you develop a more normal sleeping pattern.
Try to fall asleep at around the same time each night. This will help instill that normal sleep pattern, which positively affects your attitude for the next day.
BackerNation wishes falling asleep with back pain was as easy as counting sheep, but getting a good night’s sleep is much more complicated than that. It’s our mission to provide you the accurate information that you need to make an informed decision regarding your health.