Over The Counter Pain Relievers - Conservative Measures: Back Pain
Content provided by the Faculty of the Harvard Medical School
Over-the-counter pain relievers
Over-the-counter pain relievers — such as acetaminophen, aspirin, or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (see Table 3) — are usually all that is needed to ease acute low back pain. Aspirin and NSAIDs have an advantage over acetaminophen in their ability to reduce inflammation in strained tissues, but they also cause gastric irritation and bleeding in some people. It's important to remember that any over-the-counter medication can have toxic effects when taken in higher-than-recommended doses (see "Save your stomach, hurt your liver?").
Table 3: Over-the-counter remedies | |||||
| Drug | Brand name | How long does it take to work? | How long does it last? | Maximum daily dose | Comments |
| acetaminophen | Tylenol | 30 minutes | 4–6 hours | 4,000 mg | Not an NSAID. Fewer gastric side effects make it useful for mild pain. In high doses, possible liver and kidney toxicity. May be combined with opioids (Percocet, others) for more severe pain. |
| aspirin (acetylsalicylic acid) | Bayer, Bufferin, others | 30 minutes | 4–6 hours | 4,000 mg | Inhibits blood clotting and shouldn't be used before or after surgery. Buffered and enteric-coated versions (Bufferin, Ecotrin) may be easier on your stomach. Drugs in the same salicylate group as aspirin — such as trisalicylate (Trilisate), diflunisal (Dolobid), and salsalate (Disalcid) — are preferred for people with stomach and bleeding problems. |
| ibuprofen | Advil, Motrin, others | 30 minutes | 4–6 hours | 2,400 mg | Safer and better tolerated than aspirin. Potent inhibitor of cyclooxygenase, an enzyme involved in pain signals. |
| indomethacin | Indocin | 30 minutes | 4–6 hours | 200 mg | Used primarily to treat people with rheumatologic diseases. High rate of side effects; up to 20% of people stop using it because of headache, gastric irritation, and other problems. Sulindac (Clinoril) is a closely related drug with fewer side effects. It is a "prodrug" that doesn't become active until it is metabolized in the liver. |
| naproxen sodium | Aleve | 30 minutes | 8–12 hours | 1,100 mg | Like ibuprofen, a derivative of propionic acid, and therefore has some of the same clinical characteristics. Stays in the blood longer than ibuprofen so it needs to be taken only twice a day. Higher rates of gastrointestinal side effects than ibuprofen. |
The best pain control is achieved when the analgesic is taken on a regular schedule rather than after the pain flares up again. That's because practicing pain control is a bit like fighting a brush fire: It's better to intervene when the problem is just smoldering. If it flares up, it's much harder to damp down again.
Save your stomach, hurt your liver?People suffering from low back pain sometimes choose a pain reliever that contains acetaminophen in order to avoid the stomach upset and gastrointestinal bleeding that can result from regular use of aspirin or certain NSAIDs. But acetaminophen, like any drug, has its own risks — especially for the liver. A 2005 study in Hepatology concluded that acetaminophen was to blame for 42% of the cases of acute liver failure seen at hospitals during the study period. Many of these poisonings were accidental. To avoid an accidental poisoning, don't exceed the recommended maximum per day — generally set at 4 grams (4,000 milligrams), the equivalent of 8 extra-strength Tylenol tablets. Remember that acetaminophen is often included in combination formulas, so it's important to read all medication labels carefully. If you drink alcohol on a regular basis, it is wise to avoid acetaminophen altogether, as the threshold for toxicity for drinkers appears to be lower than it is for other people. |
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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