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There are numerous drugs in diverse classes that may benefit patients with chronic low back pain. The nonopioid analgesics include acetaminophen and the nonsteroidal anti-inflammatory drugs (NSAIDs). The cyclo-oxygenase 2 (so-called COX-2 inhibitors) are a subgroup of NSAIDs that recently became available and have a lesser likelihood of causing adverse gastroinstestinal problems. Their role is rapidly increasing. The adjuvant analgesics are drugs that have other primary indications but may be useful for the treatment of pain. Some of these drugs, such as the antidepressants and the so-called adrenergic agonists, are nonspecific analgesics and can be used for any type of back pain problems. Others, such as the anticonvulsants, the local anesthetics and others, are only used if the back pain problem includes an element of neuropathic pain. The long-term use of opioid analgesics is now recommended by pain specialists for a group of highly selected patients with chronic pain. (See introduction for more details)
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