From the Guidelines
For back pain, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours or naproxen (Aleve) at 220-440mg every 12 hours are typically recommended first. According to the most recent and highest quality study 1, acetaminophen is ineffective for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain.
Key Points to Consider:
- NSAIDs are associated with small to moderate, primarily short-term effects on pain, but also have gastrointestinal and cardiovascular risks 1.
- Acetaminophen may be a reasonable first-line option for treatment of acute or chronic low back pain due to its more favorable safety profile and low cost, but its effectiveness is limited 1.
- Muscle relaxants like cyclobenzaprine (5-10mg) or prescription-strength NSAIDs might be prescribed by a doctor for more severe pain 1.
- Opioid analgesics or tramadol are an option when used judiciously in patients with acute or chronic low back pain who have severe, disabling pain that is not controlled with acetaminophen and NSAIDs, but their use is associated with substantial risks, including aberrant drug-related behaviors and potential for abuse or addiction 1.
Important Considerations:
- Medications should be taken with food to reduce stomach irritation, and for no more than 7-10 days without consulting a healthcare provider.
- It's essential to combine medication with other treatments like gentle stretching, proper posture, applying heat or ice, and avoiding activities that worsen pain.
- If pain is severe, persists beyond two weeks, includes numbness/tingling, or affects bladder/bowel function, seek medical attention immediately as these could indicate a more serious condition requiring different treatment.
From the FDA Drug Label
Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. For the treatment of dysmenorrhea, beginning with the earliest onset of such pain, ibuprofen tablets should be given in a dose of 400 mg every 4 hours as necessary for the relief of pain.
Ibuprofen is appropriate for mild to moderate back pain. The recommended dose is 400 mg every 4 to 6 hours as necessary for relief of pain 2.
- Key points:
- Dosage: 400 mg every 4 to 6 hours
- Indication: Mild to moderate pain
- Medication: Ibuprofen
From the Research
Medication Options for Back Pain
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate back pain 3
- Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 3
- Muscle relaxants may be useful for acute low back pain 3
- For severe or refractory acute back pain, treatment can be briefly escalated with the use of medications that work on opioid and monoamine receptors (e.g., tramadol, tapentadol) or with the use of acetaminophen/opioid or NSAID/opioid combinations 3
Considerations for Specific Medications
- Paracetamol/acetaminophen is a commonly used analgesic and antipyretic drug, but it can cause liver intoxication, especially when taken regularly and in large doses (> 4 g/day) 4
- Ibuprofen plus acetaminophen does not improve outcomes within 1 week for patients with acute, nontraumatic, nonradicular low back pain compared to ibuprofen plus placebo 5
- A fixed-dose combination of ibuprofen and acetaminophen is an appealing alternative to opioids in acute pain settings, with potential benefits including reduced need for rescue opioid medication 6
Guidelines for Medication Use
- NSAIDs may have a role in managing acute and chronic back pain, with cautious use in people who may be at greater risk of experiencing adverse events 7
- Paracetamol, opioid analgesics, antibiotics, muscle relaxants, and antidepressants should only be prescribed following a discussion between the treating clinician and the patient, considering the risks and possible benefits, and after or in conjunction with recommended nonpharmacological strategies for improving back pain 7