When you’re looking for some immediate back or neckpain relief, your healthcare provider will likely suggest taking an over-the-counter pain medication. But there are several types, and the trick is knowing which to choose, and why.
As you’ll see, active ingredients can be grouped together into drug classes. As far as over-the-counter pain drugs go, the two main classes are NSAIDs (non-steroidalanti-inflammatories) and analgesics (pain relievers). Sometimes a drug will serve both purposes; other times it will not.
Most drugs come with a long list of side effects, and NSAIDs are no different. Some NSAID side effects can be very dangerous to your health; the biggest risks of taking this type of drug are renal (kidney) problems, heart attack, and stomach ulcers.
And finally, the drugs discussed below are available as a prescription in higher doses.
1
Aspirin
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Aspirin is perhaps the oldest anti-inflammatory medication known to humanity. Acetylsalicylic acid, theactive ingredientin aspirin, has been used as a pain reliever for centuries, if not millennia (in various forms.)
As an NSAID, aspirin not only reduces back or neck pain, it plays a role in controlling inflammation, which may be helpful following an injury or trauma.
Although rare, aspirin can have serious side effects, not the least of which are stomach problems. But unlike other NSAIDs, aspirin, when used correctly, mayimprove cardiovascular health. Speak to your healthcare provider about this if you would like to know more.
Because of that, many experts believe that of all the NSAIDs, aspirin is the best choice. The People’s Pharmacy, which is both an informative website and a talk radio show aired on National Public Radio puts forth this statement:
“If we were banished to a desert island and could only take one pain reliever, we’d choose aspirin.”
The reasons, they say, is that along with relieving pain and reducing inflammation, aspirin helpsreducethe risk of cardiovascular events such as heart attack or stroke. And, the People’s Pharmacy says, evidence suggests that aspirin may confer anti-cancer benefits, as well.
2
Ibuprofen
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Ibuprofen is an anti-inflammatory drug that some people take to reduce acute pain, tenderness, swelling and stiffness due to arthritis. Ibuprofen is also used to alleviate muscle aches and calm pain due to back strain.
Brand names include Motrin and Advil.
Like aspirin, ibuprofen is an NSAID, which means it not only reduces back or neck pain but plays a role in containing the process of (inflammation) itself. Anti-inflammatory drugs with ibuprofen as their active ingredient inhibit the production of prostaglandins, and therefore inflammation and pain.
Side effectsmay include stomach problems and cardiovascular events.
In 2015, the FDA, based on updated research, tightened up the wording requirements for manufacturers on ibuprofen package and Drug Facts labels. This was to inform the public about thespecific risksassociated with this active ingredient.
One of the most important warnings in this new update is that the risk of stroke or heart attack is present much earlier in the treatment course than experts originally believed.
“There is no period of use shown to be without risk,” says Judy Racoosin, M.D., M.P.H., deputy director of FDA’s Division of Anesthesia, Analgesia, and Addiction Products.
To protect yourself from unintended overdose (and therefore increased risk of serious or even fatal side effects) the FDA advises looking at the active ingredients in the Drug Facts label of each medication you take, and be sure that only one of them contains an NSAID.In other words, don’t take more than one NSAID at a time.
If you’ve had a heart attack, your risk for another one (and possibly even dying from it) is higher, too.
But everyone, regardless of their state of cardiovascular health, is put at a higher risk for taking ibuprofen, the FDA informs us.
3
Naproxen
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Naproxen, another NSAID, is used to relieve pain due tomuscle strainand arthritis. This includes osteoarthritis and inflammatory arthritis such ankylosing spondylitis.
Brand names include Aleve and Naprosyn.
Note that while all NSAIDs (with the possible exception of aspirin) raise your risk of heart attack or stroke, at least one study indicates that naproxen raises it the least.
The GI related side effects of taking NSAIDs (i.e., stomach ulcers and/or bleeding) increases the longer you take this type of drug.So it’s best to take only the lowest dose necessary for delivering pain relief.
4
Tylenol (acetaminophen)
Tylenolis the most frequently used pain reliever on the market. It can be taken for short-term relief when you have mild or moderate back or neck pain. It is not an NSAID.
But if you have liver problems, or if you consume a lot of alcohol, you should tread carefully when it comes to Tylenol. It is very easy to take too much of this drug, which may then result in serious or fatal liver toxicity.
5
Is Pain Medication Really for You?
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The authors of a 2017 study published in the journalMedicinereport that while most neck and back complaints brought to healthcare providers go away with merely the passage of time, they do tend to come back (recur).
This pain and frequency relationship is especially strong, they say, between first bouts and subsequent ones. Specifically, the longer the first episode lasts, the more the low back pain is likely to come back later. And each time it does, it will be more severe, and likely cause more disability.
In this way, your first round of back pain may make subsequent ones worse, and may also contribute to a long term chronic back condition to boot.
The authors point out that spine pain is one of the top five disabling conditions in the U.S.
Given all this, you may want to be sure that taking medication for your back or neck pain at all is, indeed, your best course of action.
Another 2017 study, this one published in theAnnals of Rheumatic Diseases, compared taking NSAIDs for spine pain with doing nothing.
While the NSAIDs did help with the pain, it wasn’t that much. In fact, the authors conclude that there really are no simple type analgesics that work well enough (as compared with placebo).
And when you factor in the risk for GI tract bleeding and/or ulcers, and/or the elevated risk for heart attack or stroke, you may want to rethink your pain relief strategy—especially if your pain is fairly mild.
One very popular strategy you might try is exercise.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Katz JA.COX-2 inhibition: What we learned–a controversial update on safety data.Pain Med. 2013;14 Suppl 1:S29-34. doi:10.1111/pme.12252
The Peoples' Pharmacy.Aspirin vs. NSAIDs: Which is best?
U.S. Food and Drug Administration.FDA drug safety communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes.
Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: Meta-analyses of individual participant data from randomised trials.The Lancet. 2013;382(9894):769-779. doi:10.1016/s0140-6736(13)60900-9.
Goldstein JL, Cryer B.Gastrointestinal injury associated with NSAID use: A case study and review of risk factors and preventative strategies.Drug Healthc Patient Saf. 2015;7:31–41. doi:10.2147/DHPS.S71976
Bashir A, Mehta D.Liver toxicity. In:StatPearls.StatPearls Publishing; 2023.
Sinnott PL, Dally SK, Trafton J, Goulet JL, Wagner TH.Trends in diagnosis of painful neck and back conditions, 2002 to 2011.Medicine. 2017;96(20):e6691. doi:10.1097/MD.0000000000006691
Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML.Non-steroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis.Ann Rheum Dis. 2017;76(7):1269-1278. doi:10.1136/annrheumdis-2016-210597
Dreisinger TE.Exercise in the management of chronic back pain.Ochsner J. 2014;14(1):101–107.
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