The invention relates to a pharmaceutical composition to reduce back pain comprising two compounds: an opioid antagonist and a direct-acting alpha 2 adrenegic agonist. The Opioid antagonist is selected from the group consisting of alvimopan, nalmefene, naloxone, naltrexone, methylnaltrexone, nalorphine, and pharmaceutically acceptable salt. The direct-acting alpha 2 adrenegic agonist is selected from a group consisting of Apraclonidine, Brimonidine, Clonidine, Detomidine, Dexmedetomidine, Guanabenz, Guanfacine, Lofexidine, Medetomidine, Romifidine, Tizanidine, Tolonidine, Xylazine and Fadolmidine. In one embodiment, the composition may include naltrexone (or its pharmaceutically acceptable salt) as the opioid antagonist and clonidine hydrochloride (or its pharmaceutically acceptable salt) as the direct-acting alpha 2 adrenegic agonist. It is preferred naltrexone be administered with a second agent such as an antitussive, expectorant, decongestant, or antihistamine. The dosage of naltrexone may range between 0.25 mg to 15 mg, while the dosage of clonidine hydrochloride ranges between 0.0125 mg and 0.3 mg.