What are the most effective medications for back pain?

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OTC medications for back pain include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These are a group of pain relief medications that work by chemically reducing the inflammatory response. They relieve many kinds of pain and inflammation. NSAIDs include naproxen, also called Aleve or Naprosyn. They also include ibuprofen, also called Advil or Motrin.
• Acetaminophen: This is a common pain relief medication that chemically blocks pain signals, relieving pain and fever. Its effects are similar to NSAIDS. However, it does not reduce inflammation. Other names for acetaminophen are Tylenol or paracetamol.

A 2021 review of these medications found that both acetaminophen and NSAIDs are effective chronic low back pain (CLBP) treatments.

However, they also found that:

• Different research into acetaminophen effectiveness yielded different results.
• Some studies questioned the effect of acetaminophen overall.
• Several studies found no difference in effectiveness between different types of NSAIDs.
• Health experts generally consider NSAIDs more effective than acetaminophen due to their anti-inflammatory effects, although one study found no difference.

They found that acetaminophen is more effective when in combination with other medications, such as ibuprofen.

Side effects

Side effects of acetaminophen may include:

• nausea
• rashes
• headaches

They may also include:

• hypersensitivity reactions, where the immune system responds excessively to some substances
• anaphylaxis, a severe potentially life threatening allergic reaction
• skin reactions
• hepatotoxicity, or liver damage
• renal tubular necrosis, which refers to damage to the kidney
• nephropathy, or kidney disease
• anemia, where the blood cannot carry as much oxygen around their body
• thrombocytopenia, a condition that affects how blood clots and bruises

Acetaminophen overuse may also cause serious liver damage.

Long-term NSAID use may lead to side effects, including:

• nausea, vomiting, and diarrhea
• heartburn
• stomach pain or gas
• constipation
• ulcers
• gastrointestinal bleeding
• high blood pressure
• heart attacks and strokes
• allergic reactions
• reduced kidney function
• reduced blood clotting, where a person:
  • bruises more easily
  • finds any cuts are slower to stop bleeding

Prescription back pain medications include certain antidepressants, muscle relaxants, prescription NSAIDs, and opioids.

Antidepressants

Healthcare professionals use antidepressants to help manage depression or sometimes to relieve chronic pain. Researchers believe antidepressants, such as duloxetine, can relieve pain by increasing the bodily production of chemicals, such as serotonin and noradrenaline. These chemicals then help block pain signals.

According to a 2023 review, serotonin-noradrenaline reuptake inhibitors (SNRIs) antidepressants are effective in treating CLBP. Some clinical guidelines recommend SNRIs such as duloxetine.

However, researchers who reviewed previous research into antidepressant effectiveness for back pain in 2021 found that:

• SNRIs can be slightly effective for back pain.
• About 2 in 3 people using SNRIs experience side effects.
• Scientific evidence for the use of SNRIs instead of other antidepressants for back pain relief is low.

Prescription NSAIDs

Prescription NSAIDs are higher-strength versions of OTC NSAID medications.

In a 2016 review, researchers investigated clinical trials into NSAID effectiveness. They included prescription NSAIDs such as celecoxib, piroxicam, and diflunisal.

They found that some NSAIDs may have a small effect on back pain. They also could not find any difference in effectiveness between different NSAID types.

Muscle relaxants

Muscle relaxants are a type of medication that relaxes the muscles and reduces tension. They also help with stiffness and pain that is the result of muscle spasms.

A healthcare professional may prescribe muscle relaxants if a person is experiencing pain relating to muscle spasms. However, they may be ineffective for general back pain.

Opioids

Opioids are natural or synthetic chemicals that reduce the intensity of pain signals.

A 2017 review of treatments for several types of back pain found some opioids may produce a small short-term improvement in CLBP. However, there appeared to have no long-term pain relief effect.

Health experts generally do not recommend opioids for long-term use, as this can lead to dependence on the medication.

Side effects

Side effects of antidepressants can include:

• sexual dysfunction
• drowsiness and insomnia
• weight gain
• anxiety
• dizziness and tremors
• headache
• dry mouth
• blurred vision
• nausea
• rash

SNRIs may also cause:

• high blood pressure
• excessive sweating
• bone loss

When taking opioids, people may develop dependence or increasing tolerance to them. Taking too many prescription opioids can also be fatal.

Opioids may also have several side effects, even if a person takes them as a doctor directs. These adverse effects include:

• constipation
• dizziness
• drowsiness
• dry mouth
• nausea
• vomiting

Prescription NSAIDs often have more side effects than OTC NSAIDs.

A person needs to contact a healthcare professional if their back pain does not improve after a few weeks. They also need to consult a doctor for back pain after a fall or injury, or if they experience any of the following symptoms:

• numbness and tingling
• severe back pain that does not improve with medication
• persistent or worsening back pain
• changes to bowel or bladder functions
• back pain and:
  • trouble urinating
  • weakness, numbness, or pain in their legs
  • fever
  • unintended weight loss

The following are answers to some questions that people frequently ask about pain medication and back pain.

What’s the strongest over-the-counter pain medication?

Naproxen is one of the most effective OTC NSAID pain medications.

What is the strongest anti-inflammatory medication?

Anti-inflammatory NSAID medications, such as ibuprofen or naproxen, are similarly effective for pain. However, their pain relief can vary from person to person.

How do you get rid of back pain fast?

Fast-acting medications for back pain include ibuprofen, also called Advil or Motrin. Oral ibuprofen typically works within 20 to 30 minutes.

Researchers believe that research shows effective over-the-counter back pain medications may include nonsteroidal anti-inflammatory drugs (NSAIDs) or combinations of acetaminophen with other medications.

They also believe effective prescription back pain medications can include serotonin-noradrenaline reuptake inhibitors antidepressants, some prescription NSAIDs, and opioids. For pain due to muscle spasms, effective medication may include muscle relaxants.

However, all medications may have side effects. A person always needs to follow recommended dosages, usage instructions, and professional medical advice when taking any form of pain medication.