Back or Neck Pain Medication — What Can Over-the-Counters Do For You?

When you're looking for some immediate back or neck pain relief, your healthcare provider will likely suggest taking an over-the-counter pain medication. But there are several types, and the trick is knowing which to choose, and why.

First let's talk about what is meant by “types” of over-the-counter pain medication. These are distinguished by the “active ingredient,” which is the chemical substance that makes the changes, for example, relieve pain, reduce inflammation, etc., that are stated on the drug package labels. (Active ingredients can cause side effects, too, so this may also play a role in your decision to take one medication over another.)

As you’ll see, active ingredients can be grouped together into drug classes. As far as over-the-counter pain drugs go, the two main classes are NSAIDs (non-steroidal anti-inflammatories) and analgesics (pain relievers). Sometimes a drug will serve both purposes; other times it will not.

All but one of the drugs described here are over-the-counter NSAIDs, which can reduce pain, fever and inflammation. COX-2 inhibitors, another kind of NSAID, may also be helpful in treating your symptoms, but these drugs are available by prescription only.

Most drugs come with a long list of side effects, and NSAIDs are no different. Some NSAID side effects can be very dangerous to your health; the biggest risks of taking this type of drug are renal (kidney) problems, heart attack, and stomach ulcers.

And finally, the drugs discussed below are available as a prescription in higher doses.



OTC Pain Meds

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Aspirin is perhaps the oldest anti-inflammatory medication known to humanity. Acetylsalicylic acid, the active ingredient in aspirin, has been used as a pain reliever for centuries, if not millennia (in various forms.)

As an NSAID, aspirin not only reduces back or neck pain, it plays a role in controlling inflammation, which may be helpful following an injury or trauma.

The active ingredient in aspirin does its work by holding back the production of prostaglandins, which are short-lived chemicals in the body, responsible for inflammation, as well as pain.

Although rare, aspirin can have serious side effects, not the least of which are stomach problems. But unlike other NSAIDs, aspirin, when used correctly, may improve cardiovascular health. Speak to your healthcare provider about this if you would like to know more.

Because of that, many experts believe that of all the NSAIDs, aspirin is the best choice. The People's Pharmacy, which is both an informative website and a talk radio show aired on National Public Radio puts forth this statement:

"If we were banished to a desert island and could only take one pain reliever, we’d choose aspirin."

The reasons, they say, is that along with relieving pain and reducing inflammation, aspirin helps reduce the risk of cardiovascular events such as heart attack or stroke. And, the People's Pharmacy says, evidence suggests that aspirin may confer anti-cancer benefits, as well.



Pain relievers

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Ibuprofen is an anti-inflammatory drug that some people take to reduce acute pain, tenderness, swelling and stiffness due to arthritis. Ibuprofen is also used to alleviate muscle aches and calm pain due to back strain.

Brand names include Motrin, Advil and Nuprin.

Like aspirin, ibuprofen is an NSAID, which means it not only reduces back or neck pain but plays a role in containing the process of (inflammation) itself. Anti-inflammatory drugs with ibuprofen as their active ingredient inhibit the production of prostaglandins, and therefore inflammation and pain.

Side effects may include stomach problems and cardiovascular events. 

In 2015, the FDA, based on updated research, tightened up the wording requirements for manufacturers on ibuprofen package and Drug Facts labels. This was to inform the public about the specific risks associated with this active ingredient. 

One of the most important warnings in this new update is that the risk of stroke or heart attack is present much earlier in the treatment course than experts originally believed. 

“There is no period of use shown to be without risk,” says Judy Racoosin, M.D., M.P.H., deputy director of FDA’s Division of Anesthesia, Analgesia, and Addiction Products.

To protect yourself from unintended overdose (and therefore increased risk of serious or even fatal side effects) the FDA advises looking at the active ingredients in the Drug Facts label of each medication you take, and be sure that only one of them contains an NSAID. In other words, don't take more than one NSAID at a time.

Another warning is that those who already have cardiovascular disease, or who have had cardiac bypass surgery are at the highest risk for a cardiovascular event associated with taking ibuprofen or other NSAID.

If you've had a heart attack, your risk for another one (and possibly even dying from it) is higher, too.

But everyone, regardless of their state of cardiovascular health, is put at a higher risk for taking ibuprofen, the FDA informs us.



Taking medication

Naproxen, another NSAID, is used to relieve pain due to muscle strain and arthritis. This includes osteoarthritis and inflammatory arthritis such ankylosing spondylitis. ​​

As with the other anti-inflammatory drugs, naproxen works largely by inhibiting the formation of prostaglandins.

Brand names include Aleve and Naprosyn.

Note that while all NSAIDs (with the possible exception of aspirin) raise your risk of heart attack or stroke, at least one study indicates that naproxen raises it the least.

This may be because naproxen is a long acting drug, where ibuprofen is short acting. A long acting drug does not need to be taken as frequently, thereby exposing you to less risk for the drug's side effects.

The GI related side effects of taking NSAIDs (i.e., stomach ulcers and/or bleeding) increases the longer you take this type of drug. So it's best to take only the lowest dose necessary for delivering pain relief.


Tylenol (acetaminophen)

Pain medication

Peter Dazeley / Photographer's Choice / Getty Images

Tylenol is the most frequently used pain reliever on the market. It can be taken for short-term relief when you have mild or moderate back or neck pain. It is not an NSAID.

Tylenol helps muscle-related back pain and/or arthritis. It may work by reducing the amount of the brain chemical that excites pain signals, thereby, affecting the central nervous system. It also exerts a cooling effect by inhibiting the prostaglandins that play a role in the brain's heat-regulating center.

But if you have liver problems, or if you consume a lot of alcohol, you should tread carefully when it comes to Tylenol. It is very easy to take too much of this drug, which may then result in serious or fatal liver toxicity.


Is Pain Medication Really for You?

Overweight mature person with lower back pain
Universal Images Group / Getty Images

The authors of a 2017 study published in the journal Medicine report that while most neck and back complaints brought to healthcare providers go away with merely the passage of time, they do tend to come back (recur).

This pain and frequency relationship is especially strong, they say, between first bouts and subsequent ones. Specifically, the longer the first episode lasts, the more the low back pain is likely to come back later. And each time it does, it will be more severe, and likely cause more disability. 

In this way, your first round of back pain may make subsequent ones worse, and may also contribute to a long term chronic back condition to boot.

The authors point out that spine pain is one of the top five disabling conditions in the U.S.

Given all this, you may want to be sure that taking medication for your back or neck pain at all is, indeed, your best course of action.

Another 2017 study, this one published in the Annals of Rheumatic Diseases, compared taking NSAIDs for spine pain with doing nothing.

While the NSAIDs did help with the pain, it wasn’t that much. In fact, the authors conclude that there really are no simple type analgesics that work well enough (as compared with placebo).

And when you factor in the risk for GI tract bleeding and/or ulcers, and/or the elevated risk for heart attack or stroke, you may want to rethink your pain relief strategy—especially if your pain is fairly mild.

One very popular strategy you might try is exercise.

A 2014 study published in the Ochsner Journal found strengthening the low back and/or neck extensor muscles (which are located in back and help you arch rather than flex or round your spine) helps reduce pain and may help you move quickly past many types of spine problems. If you see a healthcare provider about neck or back pain, consider taking a proactive approach by asking for a prescription to physical therapy.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  9. Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis. 2017;76(7):1269-1278. doi:10.1136/annrheumdis-2016-210597

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By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.