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There are several over-the-counter medications available for treating pain and inflammation in the lower back. For more severe pain, doctors may prescribe stronger medications.
In 2019,39% of U.S. adultsexperienced back pain. Lower back pain can be acute (short-term) or chronic (long-term). Acute pain typically occurs due to injury, overuse, or sleeping in an awkward position. Chronic lower back pain may result from repeated trauma or overuse of the spine.
Doctors recommend over-the-counter medications (OTC) to reduce pain and inflammation in the lower back, but they may prescribe something stronger if the pain persists.
This article outlines some common medications for lower back pain, their side effects, and dosage information. It also discusses finding help to pay for medication and complementary therapies people can try.
Learn more about lower back pain here.
What is the first-line medication a doctor will suggest?
According to a2021 meta-analysisof studies that tested medications for chronic lower back pain, doctors commonly recommend using OTC nonsteroidal anti-inflammatory drugs (NSAIDs) as the first line of treatment.
NSAIDs produce anti-inflammatory effects and pain relief, making them preferable to acetaminophen for treating lower back pain. However, in some cases, a doctor may recommend using both medications.
If OTC NSAIDs or acetaminophen do not relieve symptoms of neck pain, a doctor may recommend prescription-strength versions of these medications before moving on to stronger medications.
Learn more about acetaminophen and the NSAID ibuprofen.
Medications at a glance
The table below outlines some medications doctors may prescribe for lower back pain.
Generic nameBrand namePrescription/OTCRecommended doseSide effects
ibuprofenAdvil, MotrinOTC400–800 milligrams (mg) up to 3 times per day• constipation
• diarrhea
• gas or bloating
• dizziness
• nervousness
• ringing in the ears
naproxenAleve, AnaproxOTC• extended release : 375, 500, and 750 mg
• delayed release: 375 and 500 mg
• fast-acting forms: 220–550 mg
• capsule: 220 mg
• oral solution: 25 mg/milliliter (ml)• constipation
• gas
• excessive thirst
• headache
• dizziness
• lightheadedness
• drowsiness
• difficulty sleeping
• burning or tingling in limbs
• cold symptoms
• ringing in the ears
• hearing problems
acetaminophenTylenolOTC• tablets: 325–500 mg
• oral solution: 160 mg/5 ml
• chewable tablets: 80–160 mg
•rash
• nausea
• headachecyclobenzaprineAmrix, Fexmidprescription10–30 mg per day• dry mouth
• dizziness
• nausea
• constipation
• heartburn
• extreme tirednessOpioids:
• codeine
• oxycodone HCl
• morphine
• hydromorphone HCl
• fentanyl patch
various brand namesprescriptioneffective dose for the shortest duration needed• addiction
• nausea
• dizziness
• increased pain sensitivity
• headache
• drowsiness
• tolerance
• constipation
• dry mouth
• dizziness
• hormone changestramadolConzip, Ultramprescriptionno common dose for lower back pain• sleepiness
• headache
• nervousness
• involuntary shaking
• muscle tightness
• mood changes
• heartburn
• indigestion
• dry mouth
Over-the-counter medications
A doctor may recommend one or more OTC medications to treat lower back pain. These include:
Ibuprofen (Advil, Motrin)
Ibuprofen is a type of NSAID. NSAIDs work by non-selectively blocking cyclooxygenase (COX) 1 and 2. Inhibiting COX prevents the creation of prostaglandins, which are involved in pain, fever, and inflammation.
Doctorsoften recommendibuprofen as a first-line treatment for lower back pain.
Ibuprofen comes in several forms ranging from200–800 mg. A person may take 400–800 mg per dose up to 3 times per day.
Ibuprofen may cause side effects. If the following symptoms are severe or persist, a person should tell a doctor:
- constipation
- diarrhea
- gas or bloating
- dizziness
- nervousness
- ringing in the ears
Some side effects can be serious. If someone feels unwell or experiences unusual symptoms, they should discontinue using ibuprofen and call a doctor immediately.
Learn more about ibuprofen and its side effects here.
Naproxen (Aleve)
Naproxen, sold under the brand name Aleve, is another form of NSAID. It works the same as ibuprofen, blocking COX-1 and -2 from producing a substance that contributes to pain, inflammation, and fever.
Naproxen comes in several forms,including:
- extended-release tablets: 375, 500, and 750 mg per dose
- delayed-release tablets: 375 mg and 500 mg per dose
- fast-acting tablets: 220–550 mg per dose
- capsule: 220 mg per dose
- oral solution: 25 mg/ml per dose
The amount of naproxen a personneeds can varyby pain level. For mild to moderate arthritis, dosing may be 220–550 mg every 12 hours, not exceeding 1,650 mg daily for up to 6 months.
Naproxen may cause side effects. If the following symptoms are severe or persist, a person should tell a doctor:
- constipation
- gas
- excessive thirst
- headache
- dizziness
- lightheadedness
- drowsiness
- difficulty sleeping
- burning or tingling in limbs
- cold symptoms
- ringing in the ears
- hearing problems
Some side effects can be serious. If someone feels unwell or experiences unusual symptoms, they should discontinue using naproxen and call a doctor immediately.
Learn more about naproxen and its side effects here.
Acetaminophen (Tylenol)
Acetaminophen is an OTC medication sold under various brand names, such as Tylenol and Actamin. It relieves pain and reduces fever.
Acetaminophenworkson the hypothalamic heat-regulating center to help lower body temperatures during a fever. It also blocks the activity of cyclooxygenase (COX-3).
Children and adults can take acetaminophen, but a parent or caregiver should talk with a doctor or pharmacist before giving a child medication.
Dosing can vary based on form. Adult doses come in 325–500 mg tablets. Children’s doses are available as:
- oral solution: 160 mg/5 ml
- chewable tablets: 80–160 mg
Common side effects from acetaminophen include:
- headaches
- nausea
- rash
Some side effects can be serious. If someone feels unwell or experiences unusual symptoms, they should discontinue using acetaminophen and call a doctor immediately.
Prescription medications
A doctor may recommend prescription medication if someone reports continued pain despite using OTC options. Doctors may prescribe a stronger medication as a first-line treatment. Below are examples of prescription medications doctors may prescribe for lower back pain.
Cyclobenzaprine (Amrix, Fexmid)
Cyclobenzaprine, sold under the brand names Amrix and Fexmid, is a type of muscle relaxant. As the name suggests, it helps relax the muscles, which may relieve pain in the lower back.
Though dosing may vary, a2022 studyof clinical recommendations for lower back pain management noted that most guidelines recommend a dose of 10–30 mg daily.
Cyclobenzaprine may cause side effects. If the following symptoms are severe or persist, a person should tell a doctor:
- dry mouth
- dizziness
- nausea
- constipation
- heartburn
- extreme tiredness
Some side effects can be more serious. A person should call a doctor immediately if they feel unwell or experience unusual symptoms.
Learn more about cyclobenzaprine and its side effects here.
Opioids
Opioids are a strong class of medication that doctors prescribe for pain relief. Examples include:
- codeine
- oxycodone HCl
- morphine sulfate
- hydromorphone HCl
- fentanyl patch
Experts do not fully agree on the use of opioids. In a2022 study, researchers noted that only around half of all clinical guidelines for treating lower back pain recommend using opioids. Those that do recommend carefully controlled and short-term use only.
According to the researchers, doctors should only consider opioids for severe pain that does not respond to other medications. Dosing should be the lowest possible effective dose and generally not exceed3 daysof use for acute pain.
Possible side effects can include:
- misuse or addiction
- physical dependence
- imminent concerns of death
- nausea
- dizziness
- increased pain sensitivity
- headache
- drowsiness
- tolerance
- constipation
- dry mouth
- dizziness
- hormone changes
Learn about fentanyl here.
Tramadol (Conzip, Ultram)
Tramadol, sold under the brand names Conzip and Ultram, is a type of prescription pain medication. Like traditional opioids, it helps block nerve receptors in the brain and central nervous system.
A2022 studyfound that several clinical guidelines support using tramadol to treat lower back pain. However, there was no consensus on using tramadol for that purpose. Doctors usually do not recommend it as the first line of treatment.
Tramadol may cause side effects. If the following symptoms are severe or persist, a person should tell a doctor:
- sleepiness
- headache
- nervousness
- involuntary shaking
- muscle tightness
- mood changes
- heartburn
- indigestion
- dry mouth
Other medications
Other prescription medications can help treat lower back pain. Doctors may prescribe them if other medications are not working or to help treat an underlying condition.
In a2022 study, researchers looked at clinical guidelines and recommended medications for lower back pain. They noted that several medications doctors prescribe for lower back pain either did not make it into the reviewed guidelines or had limited data supporting their use. These medications include:
- antidepressants
- oral corticosteroids
- benzodiazepines
- antibiotics
However, a doctor may try additional medications for lower back pain based on their experience and the person’s needs.
Paying for medication
Medications, particularly prescription strengths, can be expensive even with insurance. If a person needs help paying for medications, one of the following organizations may help them reduce their costs:
OrganizationWhat they doNumberConnectiveRxaerie savings card1-844-807-9706Medicareprescription drug plans1-800-633-4227Eagle Pharmacy (EyeRx Direct)patient assistance programs1-844-813-3864PAN Foundationpatient assistance programs1-866-316-7263Blink Healthprescription drug discounts1-833-844-9621NeedyMedspatient assistance programs1-800-503-6897RxHopepatient assistance programs—Medicine Assistance Toolprescription assistance service571-350-8643PharmacyCheckercompare prescription drug prices—RxOutreachpatient assistance programs1-888-796-1234
Complementary treatments
Medications can help reduce pain and inflammation, but a person may also benefit from complementary treatments, including:
- magnesium supplements
- TENS therapy
- topical creams containing lidocaine and capsaicin
People may also find relief from applying hot and cold treatments directly to their lower back. In some cases, light exercise, such as yoga or stretching, may also help improve lower back pain.
Learn more about heat and cold therapy here.
Summary
Several prescription and OTC options are available to help treat lower back pain. Most doctors consider NSAIDs the first line of treatment, but they may recommend other options if they are ineffective.
Medications for mild back pain include ibuprofen, naproxen, and acetaminophen. More severe pain may require stronger medications, such as opioids, cyclobenzaprine, and tramadol.
A person should talk with a doctor if they have back pain that lasts longer than a few days. A doctor may be able to diagnose what is causing the pain. They may also recommend additional treatment options.