What are the over-the-counter (OTC) treatment options for a pinched nerve?

Over-the-Counter Treatment Options for a Pinched Nerve

For a pinched nerve, first-line over-the-counter treatment should include NSAIDs such as ibuprofen or naproxen, along with topical lidocaine patches or creams for localized pain relief. 1

First-Line OTC Treatments

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

• Ibuprofen: 400-600mg every 6-8 hours (not exceeding 2400mg daily)
• Naproxen: 220-440mg every 8-12 hours (not exceeding 660mg daily)
• Mechanism: Reduces inflammation around the compressed nerve, which helps decrease pain 1

Topical Treatments

• Lidocaine patches/creams (4%): Apply to the affected area for 12 hours on, 12 hours off
• Capsaicin cream (0.025-0.075%): Apply 3-4 times daily to the affected area
• Menthol/camphor products: Apply as directed for temporary relief 1

Second-Line OTC Options

Acetaminophen (Paracetamol)

• 500-1000mg every 6 hours (not exceeding 4000mg daily)
• Less effective than NSAIDs for nerve pain but useful for those who cannot tolerate NSAIDs 1

Combination Approaches

• Alternating NSAIDs with acetaminophen for continuous pain relief
• Using both topical treatments and oral medications simultaneously

Non-Pharmacological Interventions

Heat and Cold Therapy

• Cold packs: Apply for 15-20 minutes every 2-3 hours during the first 48-72 hours
• Heat therapy: After initial inflammation subsides, apply for 15-20 minutes every 2-3 hours

Rest and Activity Modification

• Avoid activities that worsen symptoms
• Maintain gentle movement without aggravating the affected area

Important Considerations and Cautions

When Using NSAIDs

• Take with food to reduce gastrointestinal side effects
• Not recommended for extended use (>10 days) without medical supervision 2
• Contraindicated in patients with:
  • History of gastrointestinal bleeding or ulcers
  • Severe heart failure
  • Advanced kidney disease
  • Third trimester of pregnancy 1

When Using Topical Treatments

• Capsaicin may cause initial burning sensation before pain relief occurs
• Lidocaine should not be applied to broken skin
• Do not cover topical treatments with heating pads 1

When to Seek Medical Attention

• Pain persists beyond 1-2 weeks despite OTC treatments
• Pain radiates beyond the initial site or causes weakness
• Symptoms include numbness, tingling, or muscle weakness
• Pain is severe and not controlled by OTC medications 1

Algorithm for Treatment Approach

1. Begin with NSAIDs (ibuprofen or naproxen) plus topical lidocaine
2. If inadequate relief after 3-5 days, add acetaminophen in alternating schedule
3. Incorporate heat/cold therapy throughout treatment
4. If no improvement after 10 days of consistent treatment, seek medical evaluation

Remember that while these OTC options can provide temporary relief, they address symptoms rather than the underlying cause of nerve compression. Persistent symptoms require professional medical evaluation to prevent long-term nerve damage.