You are not alone in finding that your typical OTC pain reliever is no longer effective for your back pain. Up to 23% of individuals experience persistent low back discomfort, per a 2018 review published in American Family Physician.1 It might take time and some trial and error to discover the proper treatment for back pain, which affects individuals of all ages.

The discomfort in your back might be a gradual ache or a severe ache. Injuries, aging, inflammation, and other medical issues are all potential culprits. Overuse injuries and repeated stress injuries are major contributors to chronic low back pain.1

Common painkillers for the back typically only work on one specific kind of back discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) are often used for inflammatory back pain. It’s often the first line of defense when it comes to relieving back discomfort.

Various drugs are available to alleviate your backache. Some can be purchased without a doctor’s prescription while others can only be obtained with one.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and provide pain relief. Examples of NSAIDs include ibuprofen (Advil) and naproxen (Aleve). These medications are often recommended as a first-line treatment for back pain, although their effectiveness may vary depending on the type of back pain.

A 2020 review suggests that NSAIDs are only slightly more effective than placebo treatments in reducing short-term back pain. However, they may be more beneficial for back pain caused by inflammatory conditions such as arthritis, as they target inflammation specifically.

It’s important to note that while NSAIDs can be taken by most healthy adults for occasional pain relief, there are potential side effects to consider. These include stomach ulcers and kidney dysfunction. It’s recommended to follow the recommended dosage and duration of use, and to consult with a healthcare professional if you have any concerns or pre-existing medical conditions.

Acetaminophen

Tylenol, or acetaminophen, is an over-the-counter pain reliever and fever reducer commonly used for various types of pain, including chronic low back pain. It is often recommended because it has a low risk of side effects compared to other pain medications.

Acetaminophen can be more effective when used in combination with NSAIDs (nonsteroidal anti-inflammatory drugs) for back pain relief. Combining these medications may provide enhanced pain relief.

Additionally, studies have shown that acetaminophen can help reduce the need for opioid medications in cases of severe back pain, which is beneficial considering the potential risks associated with opioids.

However, it’s important to note that acetaminophen is not without its own side effects. These can include skin rashes, anemia, liver toxicity, and liver dysfunction. It’s essential to follow the recommended dosage and guidelines for acetaminophen use, and consult with a healthcare professional if you have any concerns or pre-existing medical conditions.

As with any medication, it’s important to weigh the potential benefits and risks and discuss with a healthcare provider to determine the most appropriate and effective treatment approach for your specific condition.

Muscle Relaxants

Muscle relaxants are a type of medication commonly used to relieve back pain caused by muscle tension. They work by targeting the muscles in the back and promoting relaxation, which can help alleviate pain and improve movement.

Some commonly prescribed muscle relaxants include Flexeril (cyclobenzaprine), Zanaflex (tizanidine), and Glabofen (baclofen). These medications have a muscle-relaxing effect on the body.

It’s important to note that muscle relaxants can cause drowsiness and sedation. For this reason, it is often recommended to take the first dose at night to assess how it affects you. Additionally, muscle relaxants are typically prescribed for short-term use due to the risk of dependence when used for prolonged periods.

Anti-seizure Medications

If you are experiencing chronic neuropathic pain, which is caused by nerve damage affecting the transmission of pain signals between the spinal cord and brain, your healthcare provider may prescribe an anti-seizure medication to help manage your symptoms. Neuropathic pain in the back often manifests as shooting pain sensations that radiate down the hip or leg, such as in the case of sciatica.

Anti-seizure medications are effective in interrupting the pain signals being transmitted to the brain, providing relief from neuropathic pain. Examples of commonly prescribed anti-seizure medications used in chronic pain management include Neurontin (gabapentin) and Lyrica (pregabalin).

It’s important to be aware that anti-seizure medications can have side effects, including drowsiness, dizziness, and peripheral edema (swelling). These side effects can vary in severity and individual tolerance. It’s recommended to discuss any concerns or potential side effects with your healthcare provider before starting or adjusting your medication.

Antidepressants

Antidepressant medications are sometimes prescribed to treat specific types of back pain. Although these medications are primarily used to manage depression and anxiety, low doses can also be effective in reducing back pain, even in individuals who are not experiencing depressive symptoms. The mechanism of action of antidepressants in pain management involves their ability to interrupt pain signals being transmitted to the brain, which can help alleviate back pain.

Commonly used antidepressants for chronic pain management in the context of back pain include Elavil (amitriptyline), Pamelor (nortriptyline), Cymbalta (duloxetine), and Effexor (venlafaxine).

It’s important to note that antidepressants may have side effects, such as sleep disturbances and sexual dysfunction. These side effects can vary in intensity and individual response. It’s recommended to discuss any concerns or potential side effects with your healthcare provider before starting or adjusting your medication.

Dosage and treatment plans will be determined by your healthcare provider based on your specific condition and individual needs. It’s crucial to adhere to their instructions and maintain open communication regarding any changes or concerns throughout the course of your treatment.

Opioid Pain Relievers

Opioid pain medications are occasionally prescribed for the treatment of severe, acute back pain, such as after surgery or in cases of new injuries. However, they are not suitable for long-term use due to their highly addictive nature and the serious risk of dependence and abuse associated with them.

A study conducted in 2018 found that opioids were not more effective than non-opioid medications in treating chronic back pain. Furthermore, opioids were associated with a higher incidence of side effects compared to non-opioid pain medications.

Common examples of opioids include morphine, oxycodone, and hydrocodone.

Potential side effects of opioids include gastrointestinal disturbances, the development of tolerance, substance abuse, and depression.

Long-term use of opioids has been linked to unfavorable pain outcomes, difficulty performing daily activities, and a decreased likelihood of returning to work.

If you suspect that you may be dependent on opioids, it is important to seek immediate assistance from a trusted healthcare provider for proper evaluation and guidance. They can help you navigate the process of managing and potentially discontinuing opioid use safely.

Topical Pain Relievers

Topical pain relievers, such as creams, gels, and patches, can be applied directly to the skin on the back to provide localized relief. They can be a suitable alternative if oral pain medications are not well-tolerated due to side effects.

There are two common types of topical pain relievers used for back pain: capsaicin and lidocaine. Capsaicin is derived from chili peppers and is available in cream form, while lidocaine can be found in creams and patches. When used in combination with oral pain medications, topical treatments typically have a low risk of side effects.

It’s important to note that topical back pain treatments may cause side effects such as rashes, swelling, or a burning sensation at the application site. Additionally, it’s recommended to follow the instructions provided and not wear patches for longer than the specified duration, usually up to 12 hours.

If you have any concerns or experience unusual reactions to topical pain relievers, it’s advisable to consult your healthcare provider for further guidance.

Non-Medication Pain Relievers

Absolutely! Along with medications, there are several non-medication approaches and lifestyle changes that can help alleviate back pain. Here are some strategies supported by studies:

1. Physical activity: Engaging in regular physical activity and exercises, such as walking, swimming, or low-impact aerobics, can help strengthen the muscles that support the back and improve flexibility.

2. Core strengthening: Focusing on strengthening the core muscles, including the abdominal and back muscles, can provide stability and support to the spine.

3. Regular stretching: Incorporating stretching exercises into your routine can help improve flexibility and relieve muscle tension in the back.

4. Yoga: Practicing yoga has been found to be beneficial for back pain, as it combines physical movement, stretching, and relaxation techniques.

5. Heat therapy: Applying heat to the affected area, such as using a heating pad or taking a warm bath, can help relax muscles and alleviate pain.

6. Ice packs: Applying ice packs or cold compresses to the back can help reduce inflammation and numb the area, providing temporary relief.

7. Anti-inflammatory diet: Following a healthy diet that includes foods with anti-inflammatory properties, such as fruits, vegetables, whole grains, and healthy fats, may help reduce inflammation and alleviate back pain.

8. Never smoking: Smoking has been linked to an increased risk of back pain and delayed healing. Quitting smoking can improve overall health and potentially alleviate back pain.

9. Maintaining a healthy weight: Excess weight can strain the back and contribute to back pain. Maintaining a healthy weight through proper nutrition and regular exercise can help reduce the burden on the back.

10. Adequate sleep: Getting enough quality sleep is important for overall health and can contribute to pain management and recovery.

11. Cognitive-behavioral therapy: Working with a therapist trained in cognitive-behavioral therapy can help address any psychological factors that may be contributing to your back pain and develop coping strategies.

12. Chiropractic care: Seeking chiropractic care, which involves spinal adjustments and manipulations, may provide relief for some individuals with back pain.

13. Acupuncture: Acupuncture, an ancient Chinese practice involving the insertion of thin needles at specific points in the body, has been shown to be effective in reducing back pain for some people.

14. Spinal manipulation: In addition to chiropractic care, other manual therapies, such as osteopathic manipulation or physical therapy, may include spinal manipulation techniques to relieve back pain.

15. TENS unit (transcutaneous electrical nerve stimulation): This therapy involves the use of a small device that delivers low-voltage electrical currents to the affected area, helping to alleviate pain by interfering with pain signals.

It’s important to note that the effectiveness of these approaches may vary among individuals, and it’s recommended to consult with a healthcare provider before starting any new treatment or exercise program to ensure it’s appropriate for your specific condition.

Causes of Back Pain

Back pain can have various causes, and understanding the underlying factors can help in managing and treating the pain effectively. Here are some common causes of back pain:

1. Injury or damage to the back or spine: Accidents, falls, strains, sprains, and conditions like herniated discs or spinal stenosis can result in back pain.

2. Nerve pain: Nerve-related pain, such as sciatica, occurs when the nerves in the spine are compressed or irritated. This can cause sharp pain that radiates down the leg.

3. Medical conditions: Certain medical conditions can contribute to back pain. Examples include arthritis (such as osteoarthritis or rheumatoid arthritis), osteoporosis (weakening of the bones), tumors, kidney infections, and fibromyalgia (a chronic pain disorder).

4. Pregnancy: Pregnancy can lead to back pain due to hormonal changes, weight gain, and the shifting of the body’s center of gravity, which can strain the back.

5. Obesity: Excess weight, especially around the midsection, can place additional stress on the spine and contribute to back pain.

6. Poor posture and ergonomics: Slouching, sitting or standing for prolonged periods in an incorrect posture, and using improper lifting techniques can strain the back and lead to pain.

7. Sedentary lifestyle: Lack of regular physical activity weakens the muscles that support the back, making it more susceptible to pain and injuries.

8. Psychological factors: Stress, anxiety, and depression can contribute to or exacerbate back pain by increasing muscle tension and affecting pain perception.

9. Age-related changes: Degenerative changes in the spine, such as degenerative disc disease or spinal osteoarthritis, are more common with age and can result in back pain.

10. Other factors: Smoking, poor sleeping habits, nutritional deficiencies, and certain occupational factors (such as heavy lifting, repetitive tasks, or prolonged sitting) can also contribute to back pain.

It’s important to note that back pain can have multiple contributing factors, and a thorough evaluation by a healthcare professional is essential for accurate diagnosis and personalized treatment.

When to See a Healthcare Provider

When experiencing chronic or acute back pain, it is crucial to seek medical attention to determine the underlying cause and receive appropriate treatment. Here are some important points to consider:

• Consult with your healthcare provider: They will assess your symptoms, conduct a physical examination, and may recommend additional tests or imaging studies to diagnose the cause of your back pain.
  
• Importance of prompt medical attention: Severe, sudden back pain may indicate a serious underlying condition that requires immediate medical attention. It is important not to ignore such symptoms and seek prompt evaluation and treatment.
  
• Individualized treatment approach: Treatment for back pain depends on the underlying cause and the individual’s specific situation. Your healthcare provider will work with you to develop a personalized treatment plan that may include pain-relieving medication, among other interventions.
  
• Pain medication options: There are different types of pain medications available, and the choice of medication depends on the type and severity of your pain. Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can be effective for mild to moderate pain. For more severe pain, your healthcare provider may prescribe stronger medications, such as muscle relaxants, opioids, or certain types of antidepressants or antiseizure medications.
  
• Regular communication with your provider: If your current pain medication is not effectively managing your back pain, it is important to have open and ongoing communication with your healthcare provider. They can reassess your condition, adjust your medication regimen if necessary, or explore other treatment options that may be more suitable for your specific needs.

Remember, it is essential to follow your healthcare provider’s guidance and instructions regarding the use of pain medications. They can provide you with the necessary information on dosing, potential side effects, and precautions to ensure safe and effective use of the medication.

A Quick Review

It is important to consult with your doctor if your back pain is not responding to pain relievers or if you have concerns about your symptoms. Your doctor can evaluate your condition, identify the underlying cause of your back pain, and recommend appropriate treatments. They may suggest alternative pain medications or combination therapies tailored to your specific needs.

Additionally, it’s worth mentioning that while medications can provide temporary relief, addressing the underlying cause of back pain and adopting lifestyle modifications can also be beneficial in managing and preventing future episodes of pain. Your doctor can guide you in developing a comprehensive treatment plan that may include physical therapy, exercise, stretching, posture correction, weight management, and other interventions based on the cause and severity of your back pain.

Remember to follow your doctor’s instructions and discuss any concerns or questions you may have regarding your back pain and its treatment.