Medications

Acetaminophen (Tylenol) is a safe and effective pain reliever for mild to moderate acute back pain. It is also used as a fever reducer. The benefits are usually felt 30 - 60 minutes after ingestion, and it can be taken every 4 - 6 hours. Side effects can include skin rashes or inflammation, and in rare cases, damage to the liver or kidneys.

The most commonly prescribed medications for the treatment of back pain are nonsteroidal anti-inflammatory drugs (NSAIDs). Short-term use of NSAIDs may help some patients with acute back pain. The benefits of NSAIDs for chronic back pain are less certain.

There are dozens of available NSAIDs:

• Over-the-counter (OTC) NSAIDs include aspirin, ibuprofen (Motrin IB, Advil, Nuprin, Rufen), naproxen (Aleve), ketoprofen (Actron, Orudis KT).
• Prescription NSAIDs include ibuprofen (Motrin), naproxen (Naprosyn, Anaprox), flurbiprofen (Ansaid), diclofenac (Voltaren), tolmetin (Tolectin), ketoprofen (Orudis, Oruvail), and dexibuprofen (Seractil).
• COX-2 inhibitor celecoxib (Celebrex) is a special type of prescription NSAID that is less likely to cause gastrointestinal bleeding and ulcers.

While widely available and generally safe for most patients when used on a short-term basis, long-term use of these drugs carries several side effects. The FDA has issued "black box" warnings, the FDA's strongest, around risks for heart disease, ulcers and gastrointestinal bleeding:

• Heart disease: These drugs may raise the risk of a heart attack or stroke. this risk is probably higher with long-term, regular use, especially for people who have a heart condition.
• Upset stomach: Dyspepsia (burning bloated feeling in pit of stomach) is a common symptom. Taking NSAIDs with food can reduce stomach discomfort, although it may slow down the pain-relieving effect.
• Ulcers and gastrointestinal bleeding: Long-term use of NSAIDs is also the second most common cause of ulcers and gastrointestinal bleeding.

Those at highest risk for bleeding include people over age 60, anyone with a history of ulcers or gastrointestinal bleeding, patients with serious heart conditions, people who abuse alcohol, and those who take medications such as anticoagulants (blood thinners) and corticosteroids.

Proton-pump inhibitor (PPI) drugs may help prevent and heal ulcers caused by NSAIDs. PPIs include omeprrazole (Prilosec), esomeprazole (Nexium), and iansoprazole (Prevacid).

To reduce the risks associated with NSAIDs, take the lowest dose possible for pain relief. Always talk with your health care provider before using any of these drugs on a regular basis.

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Review Date: 04/07/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)