Strong Painkillers for Lower Back Pain

Most of us have a bottle of Advil or Tylenol in our medicine cabinets to ease minor aches and pains. But, when lower back pain becomes an everyday issue, what’s the next step? Medications are one of the primary treatments for lower back pain, and while they can help with daily discomfort, they come with various risks. 

In this article, we’ll explore painkillers for lower back pain and how to best use them on your journey to pain relief. When they’re used safely and sparingly, painkillers can have a positive impact on your back pain treatment plan.  

Table of Contents

Why Is Back Pain So Hard to Treat?

Back pain is so hard to treat because the spine is one of the most complex structures in the body. With a complicated system of nerves, tendons, ligaments, and vertebrae, back pain can indicate a vast range of injuries and conditions. This can make it challenging to pinpoint the exact cause of a patient’s back pain, let alone eliminate it. 

Additionally, different types of back pain can present with very similar symptoms. For example, the symptoms of spinal disc damage can be virtually identical to those of spinal soft tissue damage. This makes it challenging for physicians to know which area of the spine to address. 

It’s also worth noting that back pain can be hard to treat simply because it’s such a prevalent medical issue today. Hundreds of millions of people across the globe experience back pain, but the effectiveness of certain treatments can vary significantly from person to person. So, although back pain is extremely common, patients generally need an individualized treatment approach. 

When Are Painkillers Used to Treat Back Pain?

Painkillers are typically used to treat back pain along with physical therapy and lifestyle adjustments. This combination is often the first treatment approach used for back pain that doesn’t resolve on its own.  

Before prescribing painkillers, most physicians will recommend over-the-counter (OTC) medications. OTC medications are available at drugstores without a prescription because they’re considered safe to take without monitoring from a physician. These drugs typically contain lower dosages and a lower risk of side effects when compared to prescription painkillers.

What Is a Safe Painkiller for Back Pain?

Over-the-counter NSAIDs are widely considered to be safe painkillers for back pain.

NSAIDs stands for nonsteroidal anti-inflammatory drugs. These medications work by blocking an enzyme, cyclooxygenase, to reduce prostaglandin production. This, in turn, reduces inflammation and pain. 

A variety of NSAIDs are available over the counter, including aspirin, ibuprofen, ketoprofen, and naproxen. Ibuprofen and naproxen are among the most widely recommended for treating back pain. Ibuprofen provides rapid pain relief, while naproxen offers long-term pain relief (all day or all night, depending on when you take the pill). 

Risks and Side Effects of Over-the-Counter NSAIDs

Though over-the-counter NSAIDs are considered a safe choice of painkiller for many back pain patients, it comes with a few risks and side effects. 


First off, patients should know that NSAIDs aren’t a long-term solution to lower back pain. These medications typically aren’t intended to be taken for more than 10 days, unless your physician advises you to do so. The longer you take NSAIDs, the more likely you are to experience side effects and health risks. 

Additionally, NSAIDs increase the risk of severe stomach and bowel side effects, such as bleeding and ulcers. In patients who have a history of stomach ulcers or bleeding, are taking blood thinners, consume three (or more) alcoholic drinks per day, are taking multiple NSAIDs, or are older in age, this risk is even higher.

Non-aspirin NSAIDs also increase patients’ risks of stroke or heart attack. For this reason, it’s advised to avoid non-aspirin NSAIDs before and after heart bypass surgery.     

Side Effects

Like virtually any medication, over-the-counter NSAIDs can lead to side effects. While some of these side effects are minor and can be easily tolerated, others can be disruptive to your daily routine. In some cases, side effects indicate an underlying health problem, which is why you should always discuss your side effects with your physician.  

The most common side effects of NSAIDs include:

  • Bloating
  • Gas
  • Stomach pain and discomfort
  • Heartburn
  • Nausea
  • Constipation
  • Diarrhea
  • Dizziness or lightheadedness
  • Mild headache

Is Paracetamol or Ibuprofen Better for Lower Back Pain?

The choice of whether paracetamol or ibuprofen is better for lower back pain will depend on the patient’s symptoms, preferences, and medical history. These medications each offer unique benefits and drawbacks, so there’s no clear-cut answer to this question. 

Paracetamol (also known as acetaminophen) is an analgesic and antipyretic drug that’s widely used to treat pain and fever. Unlike ibuprofen, paracetamol isn’t an anti-inflammatory medication, so it will only help with pain in the back – not swelling. 

With that said paracetamol can be safely taken by pregnant women, unlike ibuprofen. It’s also gentler on the stomach. However, like ibuprofen, paracetamol can damage the liver if it’s taken improperly. 

Ultimately, the decision of whether to take paracetamol or ibuprofen is a personal one. Some people find that one works better than the other for relieving their symptoms. Your physician can help determine which of these medications better suits your needs.    

When Painkillers Don’t Work for Back Pain

When painkillers don’t work for back pain, you’ll need to consider other treatment options. If you’re not already seeing a physical therapist for your back pain, ask your doctor for a referral. Physical therapy is considered one of the safest and most effective treatments for chronic lower back pain. 

Aside from physical therapy, your doctor may recommend medications other than painkillers to manage your symptoms. One example is skeletal muscle relaxants, which can help with muscle spasms in the back.  

Other lower back pain treatments include:

  • Cortisone injections
  • Chiropractic treatment
  • Acupuncture
  • Lifestyle changes
  • Surgery

Why Do I Still Feel Pain After Taking Painkillers?

You may still feel pain after taking painkillers because the medication doesn’t resolve your pain, but simply blocks the sensation of pain. So, after the effects of the painkillers wear off, you may still feel lower back pain. This is why painkillers are rarely recommended as a long-term treatment.

What if My Back Pain Doesn’t Go Away With Ibuprofen?

If your back pain doesn’t go away with ibuprofen, schedule an appointment with your physician. Rather than trying another over-the-counter painkiller, which could put your stomach and liver at risk, talking to your doctor will help get to the root of your back pain. A qualified physician can present alternative treatment options for your symptoms. 

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Sometimes, patients with back pain that doesn’t go away with ibuprofen will eventually need surgery. Thankfully, with innovations in medical technology, patients who need spinal surgery have more options than ever. The TOPS System, for example, eliminates the need for spinal fusion during decompression surgery, allowing patients to retain their mobility while overcoming lower back pain.   

Regain your mobility with Premia Spine!

David danced at his son’s wedding

Bonnie explains why TOPS surgery was the right decision for her

Wade is back to hiking

Scott speaks about going to surgery

The Importance of Prompt Doctor Appointments for Lower Back Pain

Prompt doctor appointments for lower back pain are important because it prevents further damage that could exacerbate your symptoms. A doctor can pinpoint lifestyle activities that may be worsening your condition and advise you to stop them. This will facilitate faster symptom relief. 

Additionally, the sooner you start your treatment plan, the sooner you’ll experience relief from lower back pain. This will help you avoid major disruptions to your work, sleep, and personal life.