Which Pain Reliever Is Best for Back Pain? OTC, Prescription, and Natural Remedies

Best for fast back pain relief: Ibuprofen (Advil, Motrin)

Ibuprofen (Advil, Motrin) is an NSAID. NSAIDs work by decreasing pain and inflammation. Ibuprofen is available as branded medication and as a lower-cost generic. 

Dosage

Most OTC ibuprofen comes in 200 mg tablets and capsules. The typical OTC ibuprofen dosage is 1 to 2 pills taken by mouth every 4 to 6 hours. The maximum OTC dosage is 6 pills (1,200 mg) in 24 hours. 

Precautions and side effects

People with certain conditions should avoid NSAIDs or check with a healthcare professional before starting to take an NSAID:

• Anyone with kidney disease or diabetes needs to talk with a healthcare professional before taking NSAIDs.

• It’s best to avoid NSAIDs while pregnant.

• NSAIDs increase the risk of stomach ulcers or bleeding, heart failure, heart attack, and stroke. So it’s best to avoid them if you have many medical conditions.

Best for all day/night back pain relief: Naproxen (Aleve)

Naproxen (Aleve) is another NSAID. It works by decreasing inflammation, similar to ibuprofen. But its effects last longer than ibuprofen, so you don’t have to take it as often throughout the day. Naproxen is available as branded medication and as a lower-cost generic. 

Dosage

Naproxen is available OTC as a 220 mg tablet and capsule. A typical OTC naproxen dosage is 220 mg taken by mouth every 8 to 12 hours. The maximum OTC dosage is 3 pills (660 mg) in 24 hours. You shouldn’t take more than 2 pills (440 mg) in a 12-hour period. 

Precautions and side effects

Aleve side effects are mostly the same as those of ibuprofen. You’ll want to check with a healthcare professional if you’ve had: 

• Heart disease or stroke

• Kidney disease

• Stomach ulcers

Best for back pain relief if you can’t use NSAIDs: Acetaminophen (Tylenol)

Acetaminophen (Tylenol) decreases pain and lowers fevers. But studies have shown it’s not very useful for back pain, and many experts no longer recommend it as a treatment on its own. That said, some people who can’t take NSAIDs may prefer to try acetaminophen. It’s safe for most people. Acetaminophen is available as branded medication and as a lower-cost generic.

Dosage

A typical OTC tablet of acetaminophen is: 

• 325 mg (regular strength)

• 500 mg (extra strength)

• 650 mg (extended release)

The typical and maximum dosage depends on the specific product. In general, you shouldn’t take more than 3,000 mg to 4,000 mg of acetaminophen per day. Certain prescription pain relievers contain acetaminophen. But the FDA limits the amount of acetaminophen in these products to 325 mg per dose.

Precautions and side effects

Taking more than the recommended amount of acetaminophen can cause liver injury and other side effects. This includes acetaminophen from all sources, like OTC cold medications and prescription pain medications. So it’s important to make sure that you aren’t getting more than the maximum dose from all of your sources put together.

Best topical product for back pain relief if you can’t use oral NSAIDs

If you can’t or don’t want to take NSAIDs, you still have OTC options at the pharmacy. Consider a topical cream or gel that you can rub onto the painful area. These can be especially helpful in the setting of muscle tightness. Examples include:

• Voltaren (diclofenac) gel, which is an NSAID

• Capsaicin cream

• Menthol-containing creams, such as Bengay, Icy Hot, and Tiger Balm

Prescription NSAIDs for back pain relief

There are prescription-only NSAIDs for back pain relief. These are a bit stronger than OTC options. Some common ones are:

• Meloxicam (Mobic)

• Celecoxib (Celebrex)

• Indomethacin (Indocin)

• Topical diclofenac patch

Dosage

Prescription-strength ibuprofen is available in the following tablets:

• 400 mg

• 600 mg

• 800 mg tabs

Prescription-strength naproxen is available in

• High-dose tablets: 250 mg to 750 mg

• Delayed-release tablets: 375 mg and 500 mg

• Extended-release tablets: 375 mg to 750 mg

Precautions and side effects

Precautions and side effects of prescription NSAIDs are similar to those of the OTC versions. This is why your healthcare team will likely only prescribe a short course of them, as risks increase the longer you take them.

Muscle relaxants for back pain relief

Muscle relaxants work by relaxing large muscles (skeletal muscles). Most muscle relaxants have been around for a while, so they’re available as branded medications and lower-cost generics. 

They can be helpful for acute back pain due to muscle strain for a short period of time, but they don’t help with function. And research suggests they don’t work for chronic (ongoing) low back pain.

Dosage

Different muscle relaxants have different dosages. Here are some common ones:

• Cyclobenzaprine — 5 mg to 10 mg 3 times a day as needed

• Baclofen — 5 mg to 20 mg 3 times a day as needed

• Methocarbamol — 750 mg to 1,500 mg 3 to 4 times a day as needed

• Tizanidine — 2 mg 3 times a day as needed (maximum 36 mg in 24 hours)

Precautions and side effects

Muscle relaxers have a greater risk of side effects. For this reason, people age 65 and older should avoid taking them. Common side effects include:

• Drowsiness

• Dry mouth

• Headache

• Dizziness

• Nausea

• Constipation

Opioids for back pain relief

Experts don’t recommend opioid pain medications for the relief of acute back pain. Opioids have a high risk for tolerance and addiction. Plus, they aren’t more effective than non-opioid medications for acute back or neck pain.

1. Activity

Moving your body at home can help with back pain symptoms. In fact, experts recommend staying active when you have back pain, as it can help with pain and function.

A home exercise regimen is a safe way to try to improve back pain on your own, without needing someone else’s help. This can include walking, core strengthening, and stretches.

2. Massage therapy

Different types of massage therapy may help with back pain. This can be especially useful if your muscles are tense, as it can help loosen muscle tension and knots.

3. Heat

It may help to apply ice or heat to your back in the area where you feel the pain. Generally speaking, cold helps with pain due to inflammation, which can be present with an acute injury. Heat can help loosen up tight muscles. Most expert recommendations include heat as a first-choice therapy for acute back pain. Be sure to protect your skin by not applying ice or heat directly.

4. Physical therapy

Certain people are more likely to benefit from physical therapy for low back pain. Consider physical therapy if you’re prone to episodes of back pain or you also have leg pain. A healthcare professional can refer you for outpatient or at-home physical therapy if they think you’ll benefit from it. 

5. Acupuncture

Acupuncture involves placing small needles in specific points of your skin and body. It’s based on traditional Chinese medicine. And it’s very safe. Research suggests acupuncture can help improve acute back pain in the short term.

6. Spinal manipulation

Spinal manipulation is when a healthcare professional — such as a chiropractor, osteopathic physician, or physical therapist — moves the affected area with their hands. It may help with pain in some people with back pain, but studies find that it doesn’t help with function.

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