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Best anti-inflammatory medicine for back pain

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 9 minutes read

Back pain is a very common problem with around 4 out of 5 people having significant back pain at some time in their lives, and around 20 million people in the US living with chronic back pain. Fortunately, most cases are not serious, require little in the way of treatment, and gradually get better over time. In most people with back pain, it is not due to a serious disease or serious back problem, and the exact cause of the pain is not clear. This is called nonspecific lower back pain. The usual advice is to keep active, and do normal activities as much as possible. Painkillers can help until the pain eases, and in this article we look at the best types of anti-inflammatory medicines available to treat your back pain. First of all, let’s look at back pain in general.

Doctor’s advice

What are the usual causes of back pain?

The most common type is simple backache, where the pain is usually in the lower back and occasionally spreads to the thighs or buttocks. It is caused most often by a sprain or minor tear to a ligament or muscle in the back, usually from awkward or heavy lifting, twisting or bad posture (such as sitting at an incorrectly designed workstation or desk). Usually called non-specific low back pain, there is no specific problem or disease that can be identified as the cause of the pain. The severity of the pain can vary from mild to severe.

A smaller number of cases are due to a nerve being trapped as it comes out from the spinal cord and this can be due to a slipped disk, a bad muscle tear or other problems such as arthritis. This type of nerve root pain is often called sciatica and pain is felt along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot, and the pain in the leg or foot is often worse than the pain in the back. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. In cases where sciatica is caused by a slipped, or prolapsed disk in the back, part of the inner softer part of the disk bulges out (prolapses) through a weakness in the outer harder part of the disk and the prolapsed part of the disk can press on a nerve nearby and cause the pain.

What are the symptoms of back pain?

Sometimes a pain may develop immediately after you lift something heavy, or after an awkward twisting movement, and sometimes it can develop for no apparent reason. Some people just wake up one day with low back pain and this can range from mild to severe, with the pain sometimes worsened by coughing, sneezing or moving. If a nerve is trapped there may be pins and needles or numbness down one leg but most cases of back pain ease within a few weeks. However, it is quite common for further episodes to occur in the future.

Are tests needed for back pain?

No, not usually. Your doctor will usually be able to diagnose non-specific low back pain from the description of the pain, and by examining you, and in most cases no tests are needed. (There is no test that can prove or confirm non-specific low back pain.) Occasionally, tests such as X-rays, CT or MRI scans or blood tests may be advised if there are symptoms, or signs during a doctors examination, to suggest that there may be a serious underlying cause for the back pain

When should I see a doctor for back pain?

You should see a doctor if you have numbness or tingling in your back or legs, severe pain that does not improve with rest, or pain after a fall or an injury. You should also seek medical advice if you have back pain plus any of these problems:

  • Trouble urinating
  • Weakness
  • Numbness in your legs
  • Weight loss

How is back pain treated?

With a sudden ‘acute’ episode of back pain, avoid prolonged bed rest as this may make it worse. Take regular painkillers  or anti-inflammatory tablets, as this will allow regular exercise to occur. Occasionally muscle relaxants are prescribed if there is a lot of muscle spasm in the back, and some people find that manipulation of the back by an osteopath or chiropractor speeds up their recovery. Treatment may vary, and the situation should be reviewed by a doctor if the pain becomes worse, or if the pain persists beyond 4–6 weeks, or if symptoms change.

However, once the pain has eased or gone, it is common to have further bouts of pain (recurrences) from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Fortunately, most cases of simple back pain settle relatively quickly over time and can be treated with simple painkillers. For many people, nonsteroidal anti-inflammatory drugs (NSAIDs) are the treatment of choice and these can be obtained from a pharmacist, supermarket, on prescription, or from Healthwords. Examples of these include ibuprofen and diclofenac and they can be taken as tablets or used in a gel or cream (topical) form.

Most people can take NSAIDs, but some people need to be careful about taking them so ask your pharmacist or doctor for advice if you are over 65, pregnant or breastfeeding, have had stomach ulcers in the past, have asthma or have medical problems with your heart, kidneys, liver, bowels, blood pressure or circulation. You should also check before taking them if you have had allergic problems with NSAIDs in the past or you are taking other medicines.

As with any medicine there is a risk of side effects, but NSAIDs you can buy over-the-counter generally have fewer side effects than stronger prescription medicines. Possible side effects include:

  • Nausea and indigestion
  • Stomach ulcers
  • Tiredness
  • Headaches
  • Dizziness

Always take any NSAID with or after food to help reduce any irritation to the lining of your stomach. If NSAIDs are prescribed, in some cases your doctor will prescribe another medicine called a proton pump inhibitor (PPI) to help to protect your stomach. Fortunately, most people who take NSAIDs for a few days only to treat back pain experience no side effects, or only minor ones.

NSAIDs can also sometimes interact with other medicines and so may become less effective or the risk of side effects occurring may increase. Because of this, seek medical advice before taking an NSAID if you’re already taking:

  • Another NSAID
  • Any medicine used to thin the blood such as aspirin, warfarin or a direct oral anticoagulant (DOAC)
  • A diuretic (‘water tablet’)
  • Methotrexate - used to treat inflammatory conditions
  • Lithium - used to treat some mental health problems
  • Selective serotonin reuptake inhibitor (SSRI) antidepressants such as Prozac
  • Cyclosporin - a tablet used to treat conditions such as ulcerative colitis and arthritis

When taking a NSAID tablet, always take the lowest dose for the shortest time possible.

If standard painkillers or NSAIDs aren’t working for you, your doctor may suggest some additional treatments. These can include:

Acetaminophen and codeine

It is no longer recommended that acetaminophen alone is used in treating low back pain but if an NSAID does not help, or is unable to be taken, then a painkiller containing a combination of acetaminophen and codeine may be considered next, to be taken at the lowest possible dose for the shortest possible time. Because codeine is a type of opioid painkiller, it can cause the risk of addiction if used in high doses for too long. It may also cause side effects such as constipation, nausea, dizziness and drowsiness. This pain combination requires a prescription from your doctor.

The UK National Institute for Health and Care Excellence (NICE) does not recommend using benzodiazepines, opioids, antidepressants, antiepileptic drugs or gabapentinoid drugs for the management of chronic low back pain. However, there may be occasions where your doctor chooses to prescribe these for a short time if other treatments have not helped. Examples of these include:

  • Amitriptyline. This is a type of antidepressant known as a tricyclic, and can relax muscles and so help with back spasm in some people but it should be prescribed at the lowest possible dose to control your symptoms for the shortest time. Side effects include a dry mouth, drowsiness and blurred vision.
  • Gabapentin and pregabalin. These are never considered as first-line treatments for back pain but may be considered if other medications are not helping. Side effects include drowsiness, dizziness and headaches. Pregabalin has also been associated with allergic-type reactions.

Healthwords' tips for a healthy back

There are a lot of things you can do to help lower your risk of developing back pain and here at Healthwords we always follow these tips:

  • Always stretch before exercise or other strenuous physical activity.
  • Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.
  • At home or work, make sure your work surface is at a comfortable height for you.
  • Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books.
  • Wear comfortable, low-heeled shoes.
  • Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.
  • Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.
  • Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting.
  • Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
  • If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal disks to degenerate.

Following these tips as well as using NSAID tablets or rub-on gels or ointments if you have simple back pain for a few days is often all you need to do to recover and get back to your normal life. Visit our shop to see the products available for you if you have back pain. If it does not subside, if you have any of the serious symptoms mentioned in this article, or if you are worried about your back pain for any reason, always seek medical advice.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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