Doctor who has treated 40,000 patients naturally talks about pain medication

Pain medication for back pain relief     

Pain medicine for pain management

The goal of the Dr. Lumbago website is to enable the reader with acute or ongoing chronic neck pain and low back pain to so successfully manage their problem that there no need to use pain medication or muscle relaxers.  Most of the time this is goal can be reached without too much effort.  However, in a really severe problem when pain medication and muscle relaxants are needed, applying the many ideas found on this website will still enhance recovery and speed healing while minimizing the dosage and duration of drugs that are used.

If your neck and back condition is so persistent and severe that you cannot tolerate the pain any longer, and poor sleep is jeopardizing your recovery, you might decide it is time to use some pain medication or muscle relaxers.  Rather than going immediately to get prescription drug, you may want to consider using some natural muscle relaxants or over the counter pain relievers that tend to carry fewer side effects.  At this time there are many more non-prescription pain drugs than there are natural muscle relaxers for your consideration and use, and both will be discussed.

However, this article will not discuss prescription medication for chronic pain control since that is a topic best left between you and your medical doctor who knows your situation best.

Alternative to pain medication

Rather than risking side effects and complications of more and more drugs – or when drugs are no longer effective – many people seek out treatment with acupuncture or acupressure that can be extremely effective not only for pain management of chronic low back pain and neck pain, but for many underlying aspects of these problems.

Over the counter pain medication

There are only two types of over the counter pain killers: the non-steroidal anti-inflammatory drugs or NSAIDs (such as Aleve, ibuprofen and aspirin), while the other type is acetaminophen, also known as Tylenol or Aspiring Free Excedrin. All NSAIDs work similarly to do two things: 1. relieve pain and 2. reduce inflammation.  Because there is no “best” NSAID for neck and back pain, it is necessary to try a few to learn which one might work more effectively in your case. When they are taken for short periods of time, NSAIDs are safe for most people.  On the other hand, acetaminophen or Tylenol is only a pain reliever, and a good one at that, but it does not reduce inflammation; for this reason where there is a lot of obvious tissue swelling acetaminophen is probably not a good choice, although an excellent choice when inflammation and swelling is not present.  Each of these pain drugs presents both risks and benefits.

Both the NSAIDs and acetaminophen reduce fever and relieve pain associated with simple muscle aches and stiffness, but only the NSAIDs also reduce inflammation (swelling and irritation) found in acute injury.   NSAIDs and acetaminophen work differently.  NSAIDs control pain by reducing the manufacture in the central never system of the hormone-like prostaglandins, which are vital to the production of the pain signal; no prostaglandins, no pain, even if there is a reason for pain. NSAIDs are also available at a higher dosage than OTC NSAIDs in prescription strength only. Acetaminophen works on those parts of the brain that receive “pain signals” so that if the signal is being given there is no receptor to register the signal, like having the wire disconnected from the fire alarm.

NSAID safety before using for back or neck pain

All NSAID drugs pose a potential risk and have complications associated with their use. While many of the side effects are rare, a few are serious and can even be potentially fatal.  Even though NSAIDs are so commonly advertised that it is easy to forget their potential danger, it is still important for anyone who is going to use a NSAID to be aware of this potential and to seek advice and supervision by a health professional while they are being used.

As a general rule, anyone should meet with their doctor before taking any type of NSAID if any of the following apply:

  • Known allergy or reaction to aspirin, other NSAIDs or pain relievers
  • Scheduled for surgery or other invasive procedures (including dental surgery)
  • Pregnant or about to become pregnant, or breast feeding
  • Thyroid problems
  • Diabetes
  • Kidney disease
  • Heart or cardiovascular disease
  • High blood pressure
  • Consume three or more alcoholic beverages a day

It is recommended that anyone should avoid taking over-the-counter NSAIDs for longer than 10 days in succession without consulting their physician.


1.  Naproxen

This NSAID is available in both non-prescription strength (Aleve) and prescription strength (Naprosyn).  Naproxen is especially effective for back pain by reducing proteins that are  involved in the inflammation process and pain signal creation. Like other NSAIDs naproxen thins the blood and may lead to excessive bleeding, making it important for those who take blood thinners or anticoagulants to avoid its use.  It also has some adverse gastrointestinal side effects, making it important for those with active ulcers or sensitive stomachs to avoid its use; anyone using naproxen should take it with food to reduce the chance of gastric irritation.

Aleve is an NSAID used to decrease inflammation and relieve pain by inhibiting the formation of prostaglandins.  Prostaglandins are hormone-like fatty substances in the body that are critically involved in the process of inflammation that occurs after trauma or chronic tissue damage.  Aleve’s active ingredient is naproxen, which by itself is a prescription drug, is effective in reducing  pain, tenderness, swelling and joint stiffness associated with arthritis, whether it is inflammatory or non-inflammatory (rheumatoid arthritis, osteoarthritis and ankylosing spondylitis).  It can also be used to reduce inflammation and pain associated with muscle and joint strain and sprain and overuse pain.  Aleve side effects include stomach and cardiovascular problems.

2. Aspirin

Acetyl salicylic acid, the active ingredient in aspirin, has helped to relieve pain for centuries. Aspirin not only reduces back or neck pain, it is also very effective in minimizing the process of inflammation and in so doing will reduce pain and joint stiffness commonly seen in many cases of low back and neck pain.  Aspirin slows the production of prostaglandins, a series of short lived chemicals found in all mammals that are hormone-like substances involved in a wide range of functions (regulation of tissue inflammation and pain signals, control of blood pressure, contraction and relaxation of smooth muscle, and dilation and constriction of blood vessels).  It has been said that if aspirin were discovered today it would have a difficult time being given approval by the FDA because it has serious multiple  side effects.  Although aspirin is good for pain control and inflammation reduction, these benefits are sometimes outweighed by the problems it can cause with increased bleeding time, stomach ulceration and cardiovascular events it can cause after prolonged use.

3. Ibuprofen (Advil, Motrin, Nurofen, and Nuprin)

Ibuprofen is a popular NSAID taken to as reduce  the pain of  acute and chronic neck and back pain associated with overuse sprain and strain injury and simple muscle aches; it is also used to reduce pain, tenderness, tissue swelling and joint stiffness that are common in people who have arthritis, as well as relief of fever, and painful menstruation. Ibuprofen has an anti-platelet effect that is more mild and somewhat short-lived compared to aspirin, and for this reason is a less problematic alternative.

Patients with back and neck problems are commonly prescribed ibuprofen to relieve mild or moderate back pain, neck pain, inflammation, tenderness, and reduced range of motion. Common situations that are appropriate for ibuprofen use:

  • Activity-related pain or discomfort (painful condition that develops after exertion such as housework, sports, auto accident, etc.)
  • Pain in low back caused muscle strain in the low back
  • Neck pain and stiffness related to muscle, tendon or ligament strains or sprains

Because it is a NSAID, ibuprofen works by inhibiting the production of prostaglandins, and therefore minimizes tissue inflammation and pain. Ibuprofen not only is a powerful way to reduce back or neck pain but it will reduce the process of inflammation that occurs with all injury and chronic tissue problems like arthritis and other recurring soft tissue problems.   Like all NSAID drugs, ibuprofen has that include stomach problems and cardiovascular events.  Ibuprofen is listed as a ‘core’ medicine by the World Health Organization, meaning it is a minimum medical need for a basic healthcare delivery system.

Ibuprofen has aspirin-like effects on the stomach, so anyone with gastrointestinal ulcers or stomach sensitivity would be wise to limit or avoid its use.  To reduce the chance if stomach irritation is best to take ibuprofen at the beginning of a meal, and not by itself with water.  Also, ibuprofen present exerts a mild blood thinning effect, like aspirin, that lasts a few hours.  Anyone who takes blood pressure medication or diuretics should know that it reduces and interferes with these drugs and consult the prescribing physician for advice before taking ibuprofen.

Acetaminophen (Tylenol, Aspirin Free Excedrin)

1. Tylenol (acetaminophen)

Acetaminophen is said to be the single most effective non-prescription medication for lower back pain and neck pain, and it has the fewest side effects. Most pharmacies sell generic versions of acetaminophen.

Acetaminophen is frequently recommended because it has few problems and side effects associated with its use:

  • No chance of addiction with acetaminophen
  • No way to develop a tolerance, or reduced pain relieving effect, after extended use of acetaminophen
  • No gastrointestinal (stomach) upset or cardiovascular (heart and blood vessel) problems
  • Very few cases of allergy to acetaminophen

Tylenol is primarily used to treat painful conditions in which there is little inflammation, making it the most frequently used pain reliever sold on the market. It can be taken for short-term relief when you have mild or moderate back or neck pain. It helps muscle-related back pain and/or arthritis. Acetaminophen can be used to lower a fever and soothe common headaches and other common aches and pains not related to inflammation.   Because Tylenol does not have anti-inflammatory properties it is very popular treatment choice in cases of chronic pain where little or no inflammation is found at the site of pain.  Unlike NSAIDs that are also used to reduce pain, Tylenol is safe when used appropriately.  However, it can be dangerous when used excessively in the presence of liver disease or if large amounts of alcohol are consumed while medicating with Tylenol. In these cases, fatal liver toxicity can occur.  Tylenol works by reducing prostaglandins in the central nervous system that are responsible for pain signal production.