Best Medicine for Lower Back Pain: OTC and Prescription Options

Lower back pain is one of the most common reasons for seeking medical care. In the United States, as many as 25% of adults report recent lower back pain. 

There are many causes of lower back pain, such as an injury, accident, muscle strain, or poor posture.

Lower back pain can range in intensity from a dull ache to sudden sharp shooting pain. Irrespective of pain intensity, there are medications available for relieving lower back pain.

This article discusses what causes lower back pain and what medications are available over-the-counter (OTC) and by prescription.

We also talk about things you can do at home to relieve your pain and when you should seek medical care. 

Best OTC Medicine for Lower Back Pain

The first line of treatment for acute pain (lasting less than four weeks) and chronic pain (lasting longer than 12 weeks) are nonsteroidal anti-inflammatory drugs (NSAIDs). 

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are a group of medications designed to decrease inflammation, relieve pain, and reduce fevers. 

Nearly two dozen NSAIDs are available, but they all work the same way to decrease a specific group of enzymes responsible for making hormones that affect inflammation.

When inflammation reduces, pain also lessens. 

NSAIDs commonly treat mild to moderate pain from headaches, migraines, menstrual pain, osteoarthritis, sprains, strains, and toothaches. 

Most NSAIDs are available over-the-counter (OTC).

The following are some common NSAIDs:

• Aspirin
• Ibuprofen
• Naproxen
• Meloxicam
• Diclofenac
• Celecoxib

Ibuprofen is the only NSAID approved for children and adolescents aged three months to 18 years. 

Avoid NSAIDs during pregnancy and while breastfeeding. 

Take NSAIDs with food and a glass of water to reduce the risk of an upset stomach.  

Some NSAIDs come in cream, gel, spray, or patch forms you can put onto the skin for pain relief.

Several of these products also add ingredients such as capsaicin, menthol, and lidocaine to help dull the pain sensations. 

Acetaminophen

Acetaminophen is an analgesic that relieves mild to moderate pain, including muscle aches and back pain. 

Acetaminophen is usually taken orally and is available in several forms, such as capsules, chewable tablets, and liquids.

Be sure to follow the dosing guidelines, as an accidental overdose can severely damage your liver. 

Prescription Medicine for Lower Back Pain

The following medications require a prescription from your medical care provider. 

Antidepressants

Typically, antidepressant medications relieve symptoms of depression and anxiety.

However, antidepressants can also help treat chronic lower back pain.

Duloxetine (Cymbalta) is indicated in the management of chronic musculoskeletal pain and can be used to treat chronic lower back pain.

Antidepressants can make you feel dizzy and sometimes drowsy. Also, increasing suicidal thoughts and behaviors is a side effect for people 25 and younger. 

Opioids

Opioids, also called narcotic pain medications, are a class of medications used to provide relief from moderate to severe pain.

They work by binding to opioid receptors that control pain.

Opioids for the treatment of back pain should be reserved for cases where other therapies have been exhausted and when the potential benefit outweighs the risk. 

Tramadol is often the first-line opioid for back pain.

Overuse and overprescription of opioids have led to medication misuse, leading to over two million people in the U.S. alone having substance misuse disorder.

As a result, the Centers for Disease Control and Prevention warn that opioids should not be the first line of treatment for lower back pain. Instead, they encourage trying NSAIDs and other pain relieving methods first.

When taken exactly as prescribed for a short time, opioids can significantly reduce pain. 

Do not drive or operate heavy machinery while taking opioids.

Muscle relaxants

Muscle relaxants are a group of medications designed to relax or reduce muscle tension. 

They treat muscle spasticity associated with health conditions such as cerebral palsy and multiple sclerosis. 

They can also treat muscle spasms which can cause lower back pain. 

There are six muscle relaxants approved for treating muscle spasms:

• Carisoprodol
• Chlorzoxazone
• Cyclobenzaprine
• Metaxalone
• Methocarbamol
• Orphenadrine

However, evidence supporting their effectiveness in treating muscle spasms is sparse and outdated. Because of this, only use muscle relaxants if other treatments fail. 

Combination drug therapy

Sometimes you can combine medications for greater pain relief. 

However, it gets confusing because there are many generic and brand names for medications. 

It’s best to ask your medical provider or pharmacist which medications are safe to combine.

Doing this will keep you safe and prevent an accidental overdose. 

At-Home Treatments for Musculoskeletal Lower Back Pain

Here are some non-drug-related tips to help ease your back pain. 

Stay active

Despite common belief, keeping active rather than laying in bed is best for your back.

However, avoid heavy exercise, heavy lifting, bending at the waist, and movements that cause pain.

Instead, try gentle movements such as walking and yoga. 

Strengthening your core can help your back pain as well. 

If you need help determining what exercises are best for you, speak to your doctor or seek the advice of a physical therapist. 

Stretching

Gently stretching your lower back is another way to reduce pain. 

Common yoga stretches may relieve lower back pain, especially if you have tight muscles. 

Hot and cold therapy

Cold packs may help relieve some back pain. Try wrapping a bag of frozen veggies or an ice pack in a towel and icing your lower back. 

Hot packs help to promote healing by increasing blood flow in the muscles and tissue of the lower back. 

What Causes Lower Back Pain? 

Your back is a complex network of structures that work together to support your body. Problems with any of the structures can cause back pain. 

Mechanical or structural problems

If something goes wrong with any of the moving parts of your back, you can develop pain. The moving parts consist of your spine, vertebrae, muscles, ligaments, and tendons. 

• Sprain: a sprain is an injury to a ligament that supports the spine. Sprains usually happen with twisting or improperly lifting something heavy, and the ligament becomes overstretched or torn. 

• Strain: a strain is a tear to a muscle or tendon from an injury, accident, or overuse. 

• Degenerative disc disease: over time, the discs between the vertebrae start to break down; this can cause pain.

• Herniated or ruptured discs: In this case, the disc between a vertebra is compressed and bulges, irritating nearby nerves.

• Spondylolisthesis: a condition when a vertebra in the lower spine slips out of place and pinches the nerves exiting the spinal cord.

• Spinal stenosis: the spinal column becomes more narrow in an area, putting pressure on the spinal cord and surrounding nerves.

• Fractured vertebrae: occurs when an injury fractures a vertebra.

• Scoliosis: a condition present at birth that changes the shape of the spine.

• Cauda equina syndrome: is when the nerve roots in the spinal canal are compressed. This can result in permanent damage and disability if left untreated. 

Inflammatory conditions

Conditions that cause inflammation in the spine can cause back pain, including:

• Arthritis: an inflammatory disease that can affect the spine. Several types of arthritis exist, including osteoarthritis, rheumatoid arthritis, and spondylitis. 

• Infections: infections can attack several areas of the back, including, osteomyelitis (infection of the vertebrae), discitis (infection of the intervertebral discs), and sacroiliitis (infection of the joints connecting the lower spine to the pelvis). 

Other medical conditions

• Osteoporosis: progressive loss of bone density and strength, which can lead to painful vertebrae fractures.

• Fibromyalgia: a syndrome of chronic pain and muscle fatigue throughout the body. 

• Endometriosis: a build-up of uterine tissue growing outside the uterus.

• Tumors: in rare occasions, tumors develop in the spine and press on or destroy the vertebrae or spinal column.

• Pregnancy: the added weight of pregnancy and shifting of the hips in preparation for childbirth can cause lower back pain. The pain usually resolves after giving birth.

When to See a Medical Provider

If you are experiencing pain in your lower back that keeps you from performing your daily activities, or if your pain lingers for two weeks, seek medical care for diagnosis and treatment. 

Seek medical treatment immediately if you experienced trauma such as a fall, injury, or motor vehicle accident and are now experiencing extreme pain, numbness, weakness, or difficulty with bowel movement or urination.

Go to the emergency room if your back pain is associated with chest pain, abdominal pain, weakness or numbness in your arms or leg, loss of bowel or bladder control, or fever.

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