The 6 Best Ways to Treat Acute Back Pain

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Only a third of people who have acute back pain see their doctor. In some ways this is good news—it implies that most improve on their own. If you have new onset back pain, (that you’ve been experiencing for less than 4 weeks), here some OTC and prescription medication options that can help you.

  1. Nonsteroidal anti-inflammatory drugs (NSAIDS). You will see more improvement of your symptoms after 1 week of taking NSAIDS than taking nothing. Motrin/Advil (ibuprofen) or Aleve (naproxen), all available without a prescription, are all good options for you. Ibuprofen can be taken 400 – 600 mg at a time, 4 times a day, and naproxen can be taken 220 mg twice daily for improvement of back pain. In studies, NSAIDS provide more relief of back pain than Tylenol (acetaminophen). Try it as a first line choice.
  2. Acetaminophen at higher doses, 1000 mg taken 4 times a day, does help modestly with back pain. Tylenol (acetaminophen) is better tolerated than NSAIDS, causing less stomach discomfort. This is your second choice after NSAIDS for the treatment of acute back pain. The usual warning here is not to take it for longer than 10 days at those doses.
  3. What about both together? Studies suggests that there is little, if any, benefit of adding NSAID therapy to high-dose acetaminophen.
  4. What about herbal options? Herbal non-steroidals may be effective. Willow bark extract works as an anti-inflammatory and may help for back pain. The bark of white willow contains salicin, which is similar to aspirin. In one study, the relief provided by willow bark was equivalent to the prescription COX-2 inhibitor rofecoxib (no longer available in the U.S.).
  5. What about muscle relaxants? Most of these are prescription-only and not available over the counter. Muscle relaxants result in skeletal muscle relaxation and relief of muscle spasm. Muscle relaxants like Flexeril (cyclobenzaprine) and Soma (carisoprodol) will make you sleepy, so less sedating options like Robaxin (methocarbamol), and Skelaxin (metaxalone) are useful. These work for the short term relief of low back pain and they are all equivalent in how well they work.
  6. The best acute back pain cocktail: The combination of a muscle relaxant and an NSAID provided the most effective symptom relief at one week in a study of over 200 patients with their first episode of back pain. Muscle relaxants should only be used for one to three weeks.

But what about opioids like hydrocodone/oxycodone/Vicodin/Norco? For acute back pain (again, less than 4 weeks), there is limited evidence that opioids work well or are safe to take. For example, one study of patients coming to the emergency room with two weeks or less of acute low back pain found that naproxen alone was just as good as naproxen + oxycodone.

What worked for you?

Dr O.

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