Over-the-counter (OTC) anti-inflammatory medications are a common starting place for back pain. The best choice generally depends on the cause of your pain.
Both short- and long-term back pain are common symptoms that can result in a visit to the doctor. You may have already experienced back pain in your life and were pointed toward a particular medication.
Finding the best medication for back pain depends on the cause of your pain and how long you have had it. There are different medication classes you may consider depending on the cause of your symptoms.
First-line recommendations include OTC medications, which may offer relief. But you might also consider trying prescription medication when your pain is severe and limiting or adjusting the lifestyle factors contributing to your back pain.
When searching for OTC pain back relief, you’ll likely encounter nonsteroidal anti-inflammatory drugs (NSAIDs). This class of drugs is thought to work by reducing your inflammatory response, resulting in pain relief.
Naproxen
Like most NSAIDs, naproxen is mainly recommended for acute back pain. It may be a good option if you’re searching for all-day pain relief, as it can provide between 8 and 12 hours of benefit.
In a
Potential side effects of naproxen may include:
- indigestion
- nausea
- dizziness
- increased liver enzymes
- increased blood pressure
- reduced kidney function
- skin rash
- increased bleeding risk
- gastrointestinal ulcers
Ibuprofen
Ibuprofen (Advil) is widely recommended for all types of pain. Mild to moderate back pain related to sprains or strains is a common reason that you may reach for ibuprofen.
Its actions mimic naproxen, but it usually lasts between 4 and 6 hours, so you would have to take it more frequently. Additionally, while naproxen typically takes an hour to start working, ibuprofen generally only takes 20 to 30 minutes.
Potential side effects of ibuprofen may include:
- gastrointestinal bleeding
- gastrointestinal ulcers
- stomach inflammation
- headaches
- nausea or vomiting
- dizziness
- reduced kidney function
- skin rash
- increased blood pressure
Acetaminophen
Although acetaminophen (Tylenol) is not an NSAID, its effects strongly resemble an NSAID. It’s considered an analgesic and antipyretic drug, meaning that it relieves pain and reduces fever.
Although it’s still commonly recommended for low back pain, a
Potential side effects of acetaminophen may include:
- rash
- reduced kidney function
- liver failure
- blood cell abnormalities
- electrolyte disturbances
- nausea or vomiting
- constipation
- abdominal pain
- itching
You may be prescribe a pain medication if OTC medications don’t offer relief. Prescription pain relievers usually have more specific uses and can be significantly stronger than what’s available over the counter.
There are currently a few different medication classes prescribed for back pain. These include:
- NSAIDs
- muscle relaxants
- antidepressants
- opioids
Although an opioid may be prescribed, there is much caution around their use due to their high potential for misuse.
NSAIDs
Prescription NSAIDs are typically more potent than what’s available over the counter. This can result in reduced pain, but it also comes with a greater risk of side effects.
Each medication can work slightly differently, and some are reserved for particular conditions that contribute to back pain. Some common prescription NSAIDs for back pain include:
- celecoxib
- etoricoxib
- diclofenac
- ketorolac
- indomethacin
Muscle relaxants
Although muscle relaxants are sometimes prescribed for acute back pain, their overall benefit is still inconclusive, according to a
If your pain is due to a muscle spasm, it’s thought that a muscle relaxant may offer some benefit. So if you’re experiencing a back pain flare-up, you may be prescribed one of the following medications:
- cyclobenzaprine
- carisoprodol
- metaxalone
- baclofen
- methocarbamol
Antidepressants
It may seem odd, but antidepressants are also prescribed for back pain. If they are effective for you, it will usually take several weeks to notice an effect. There is an emphasis on selective-norepinephrine reuptake inhibitors as well as tricyclic antidepressants.
A
Some commonly used antidepressants for back pain include:
- duloxetine
- paroxetine
- fluoxetine
- amitriptyline
- sertraline
What opioid is prescribed for back pain?
Severe back pain may sometimes result in a hydrocodone or oxycodone prescription. Presently, the use of opioids for back pain is generally avoided due to their addictive potential and limited benefits.
A
Either as a supplement to oral medication or a replacement, you may also want to try topical creams or patches. Research from 2020 suggests applying lidocaine or capsaicin patches or cream to help manage chronic lower back pain.
While 8% capsaicin patches require a prescription, capsaicin creams are available over the counter. In addition to other pain management benefits, capsaicin — the compound found in chili peppers — can help manage muscle pain and arthritis by altering the function of the neurotransmitter that sends pain signals to the brain.
On the other hand, lidocaine cream works by numbing the skin on the part of the body experiencing pain. Lidocaine 4% patch is available over the counter. However, a lidocaine 5% patch or 1.8% topical system will require a prescription. Consider speaking with a doctor about whether topical medications are a good option for managing your back pain symptoms.
Aside from medications, there are other steps you can take to manage your back pain. Dr. Jeffrey M. DePanfilis, a chiropractic physician in Norwalk, Connecticut, suggested several important tips for managing back pain.
DePanfilis stated that a nutritious diet combined with physical activity is a crucial first step toward the reduction of back pain. He added that “both diet and exercise are big components, and core strength is really the key.”
Adjusting your posture may also play a role in managing back pain. A standing desk can help alleviate some of the strain that’s placed on your back while sitting. Adjusting to a more ergonomic seated posture can also have the same effect, according to DePanfilis.
Receiving different types of care is also important. “Everyone responds differently to treatment. You don’t have to lock yourself into one approach,” DePanfilis said. “The integration of all medical approaches, such as acupuncture and massage therapy can help you find what works best for you.”
Living with back pain can be extremely unpleasant, and it can take some time to discover which medication works best for you. When OTC medications aren’t helping, it may be worthwhile to visit a doctor and explore all of your options.
An integrative approach to back pain may include using medications combined with physical therapies such as exercise or massage. This approach may help you find temporary relief and prevent future back pain episodes.
