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Low doses of tricyclic antidepressants have been used to relieve chronic back pain. They work by increasing the level of certain chemicals in the brain that change the way the brain perceives pain. They are not used for sudden and acute pain, and usually take two to three weeks to go into effect. Side effects include constipation, dry mouth, blurred vision, drowsiness, fatigue, low blood pressure, weight gain, increased appetite, sweating, and urinary retention. Since side effects vary from medication to medication, it is worth trying another antidepressant if one does not work well. Some common antidepressants used to treat back pain are amitriptyline (Amitril, Elavil, Endep), doxepin hydrochloride (Sinequan), imipramine hydrochloride (Janimine, Tofranil), nortriptyline (Pamelor), and desipramine (Norpramin). NSAIDS and COX-2 inhibitors are effective in relieving pain and reducing inflammation. They are generally the first line of treatment in acute low back pain. NSAIDS are usually taken for one to three weeks but can be taken for


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