From the Guidelines
For back pain, the recommended NSAID regimen typically includes ibuprofen (400-800 mg three times daily) or naproxen (250-500 mg twice daily) taken with food for 1-2 weeks, as these medications have been shown to have moderate, primarily short-term benefits for patients with low back pain 1.
Key Considerations
- Start with the lowest effective dose and use for the shortest duration needed to control symptoms, as prolonged use can increase the risk of adverse effects such as stomach ulcers, kidney problems, and cardiovascular issues 1.
- Take NSAIDs with food to minimize gastrointestinal side effects.
- NSAIDs are most effective when combined with other treatments like gentle stretching, physical therapy, and proper body mechanics.
- People with kidney disease, heart conditions, history of stomach ulcers, or those taking blood thinners should consult their doctor before using NSAIDs.
Alternative Options
- Acetaminophen (500-1000 mg every 6 hours, not exceeding 3000 mg daily) may be an alternative for those who cannot take NSAIDs, though it lacks anti-inflammatory properties 1.
Important Notes
- Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy 1.
- The evidence suggests that acetaminophen is ineffective for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain 1.
From the Research
NSAID Regimen for Back Pain
- The use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) is widely recommended for the treatment of back pain, particularly for acute back pain 2, 3.
- Studies have shown that NSAIDs are effective in reducing pain intensity and disability in patients with chronic low back pain, although the magnitude of the effects is small and the level of evidence is low 3.
- Different types of NSAIDs, including non-selective NSAIDs and selective COX-2 NSAIDs, have been shown to be effective in treating back pain, with no significant differences in efficacy between them 3, 4.
Recommended NSAID Regimens
- Ibuprofen, ketorolac, and diclofenac are commonly used NSAIDs for the treatment of acute low back pain, with similar efficacy and tolerability profiles 5, 4.
- The choice of NSAID may depend on individual patient factors, such as the presence of stomach irritation or other comorbidities 4.
- Combination therapy with an opioid and an NSAID, such as hydrocodone and ibuprofen, may be effective for moderate or severe acute low back pain, but the risks and benefits of such therapy should be carefully considered 5.
Safety and Efficacy Considerations
- NSAIDs can have serious adverse effects, particularly at high doses, in the elderly, and on long-term administration, including gastrointestinal complications and organ toxicity 2, 3.
- The use of skeletal muscle relaxants, such as baclofen, metaxalone, and tizanidine, in combination with NSAIDs, does not appear to improve functional outcomes or pain in patients with acute low back pain 6.
- Patients should be carefully monitored for adverse events and the risks and benefits of NSAID therapy should be regularly reassessed 3, 4.