Acetaminophen In Treatment Of Lower Back Pain
Frank J. Domino, MDFamily Practice Recertification
Many guidelines recommend the use of acetaminophen and/or NSAIDs for the treatment of acute low back pain. The reason for this is acetaminophen and NSAIDs are relatively safe and effective with regard to managing musculoskeletal pain. This study determined the efficacy of acetaminophen alone vs. placebo for acute low back pain.
Frank J. Domino, MD
Is Acetaminophen Effective for Acute Low Back Pain, Lancet, published online
Many guidelines recommend the use of acetaminophen and/or NSAIDs for the treatment of acute low back pain. The reason for this is acetaminophen and NSAIDs are relatively safe and effective with regard to managing musculoskeletal pain. This study determined the efficacy of acetaminophen alone vs. placebo for acute low back pain.
Study Methods
This randomized controlled trial compared acetaminophen given 3 times a day for a total of 4,000 mg a day vs. PRN doses of acetaminophen to a maximum of 4,000 mg per day vs. a placebo. All patients also received patient information and best evidence advice and were followed up for 3 months. The primary outcome was recovery from acute low back pain for seven consecutive days.
Results and Outcomes
A standing dose of acetaminophen is no more effective than a PRN dose or a placebo in acute treatment of low back pain at 3 months.
The best evidence on treating acute back suggests the following:
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Aspirin: A Special Nsaid We No Longer Use For Pain
Aspirin is another analgesic available over-the-counter.
Its technically also a NSAID, but its chemical structure is a bit different from the other NSAIDs. This is what allows it to be effective in reducing strokes and heart attacks. It is also less likely to affect the kidneys than other NSAIDs are.
Aspirin is no longer used as an analgesic by the medical community. But many older adults still reach for aspirin to treat their aches and pains, because they are used to thinking of it as a painkiller. Aspirin is also included in certain over-the-counter medications, such as Excedrin.
Taking a very occasional aspirin for a headache or other pain is not terribly risky for most aging adults. But using aspirin more often increases the risk of internal bleeding. So, I discourage my older patients from using aspirin for pain.
Tips On Safer Use Of Otc Painkillers
In short, the safest oral OTC painkiller for older adults is usually acetaminophen, provided you dont exceed 3,000 mg per day.
If you have any concerns about liver function or alcohol use, plan to use the medication daily on an ongoing basis, or otherwise want to err on the safer side, try to not exceed 2,000 mg per day, and seek medical input as soon as possible.
You should also be sure to bring up any chronic pain with your parents doctor. Its important to get help identifying the underlying causes of the pain. The doctor can then help you develop a plan to manage the pain.
And dont forget to ask about non-drug treatments for pain they are often safer for older adults, but busy doctors may not bring them up unless you ask. For example, chronic pain self-management programs can be very helpful to some people.
Now if your older parent is taking acetaminophen often or every day, youll want to be sure youve accounted for all acetaminophen she might be taking. Remember, acetaminophen is often included in medications for cough and cold, and in prescription painkillers. So you need to look at the ingredients list for all medication of this type. Experts believe that half of acetaminophen overdoses are unintentional, and result from people either making mistakes with their doses or not realizing they are taking other medications containing acetaminophen.
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Back Pain Relievers For Different Types Of Pain
If your go-to over-the-counter pain medicine hasnât been touching your back pain lately, youâre not alone. According to a 2018 review in American Family Physician, chronic low back pain affects up to 23% of adults worldwide.1 Back pain is a common problem for adults of all ages, and finding the right treatment can take time and a little trial and error.
Back pain may feel dull and achy or sharp and pinching. It could be caused by an injury, age, inflammation, or other health condition. The most common causes of low back pain are repetitive trauma and overuse injuries.1
Back pain relievers are usually designed to target only one type of back pain. For example, ibuprofen is a non-steroidal anti-inflammatory drug that is effective at treating inflammatory back pain. Itâs often the first-line treatment recommended when you develop back pain. Unfortunately, most cases of back pain are not caused by inflammation.2
For Nighttime Relief: Motrin Pm
Dosage: 200 mg ibuprofen and 38 mg diphenhydramine citrate
Why experts recommend it:
The two active ingredients in Motrin PM help when you have trouble sleeping due to pain.
How it works:
Diphenhydramine is an antihistamine used to help relieve allergy symptoms. There is evidence that Some types of antihistamines can cause drowsiness, whichhelps a person sleep better or fall asleep faster.
How to use Motrin PM:
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Use as directed on the label or as instructed by your doctor
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If NSAIDs cause you to have gastrointestinal problems try taking them with food
Precautions when taking Motrin PM:
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Do not take Motrin PM for longer than 10 days or at higher doses unless instructed by your doctor
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People who take NSAIDs may have a higher heart attack or stroke risks than people who do not take these medications
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Do not drive or operate heavy machinery due to drowsiness from diphenhydramine
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There are increased risks of falls for those over 65 years of age do not take unless directed by your doctor
Common side effects of Motrin PM:
More serious side effects of Motrin PM:
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Finding The Right Treatment
Most cases of lower back pain are comparable to the common cold.
Depending on each patients unique situation and condition, conservative treatments and over-the-counter pain relievers may not address the underlying problem. In these cases, stronger medications or perhaps surgery might be the answer. Our goal is to provide the right treatment for the right condition, for the right patient, at the right time.
Times have changed, and the practice of medicine changes with time. As we learn more about lower back pain and how it works, well continue to refine our treatment recommendations. But our goal remains the same: using evidence-based medicine to give our patients safe, effective relief from back pain.
Be Careful Or Avoid This Common Class Of Painkillers
At the drugstore, the most common alternatives to acetaminophen are ibuprofen and naproxen .
Both of these are part of a class of drugs known as non-steroidal anti-inflammatory drugs . Many people are familiar with these medications. But in fact, older adults should be very careful before using NSAIDs often or regularly.
Unlike acetaminophen, which usually doesnt become much riskier as people get older, NSAIDs have side-effects that are especially likely to cause harm as people get older. These include:
- Increased risk of bleeding in the stomach, small bowel, or colon. Seniors who take daily aspirin or a blood-thinner are at especially high risk.
- Problems with the stomach lining, which can cause stomach pain or even peptic ulcer disease.
- . This can be especially problematic for those many older adults who have already experienced a chronic decline in kidney function.
- Interference with high blood pressure medications.
- Fluid retention and increased risk of heart failure.
Experts have estimated that NSAIDs cause 41,00 hospitalizations and 3,300 deaths among older adults every year.
Recent research has also suggested that NSAIDs cause a small but real increase in the risk of cardiovascular events .
Despite this fact, NSAIDs are often bought by seniors at the drugstore. Perhaps even worse, NSAIDs are often prescribed to older adults by physicians, because the anti-inflammatory effect can provide relief from arthritis pain, gout, and other common health ailments.
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Which One Works For Longer
Acetaminophen and ibuprofen both work for a similar length of time
Acetaminophen is short acting with a relatively quick onset of action. Pain-relieving effects last for three to four hours however, it is important acetaminophen is not taken more often than every four to six hours, and the maximum of 4000mg per day is not exceeded. In some cases a lower maximum dose should not be exceeded.
Ibuprofen is a short-acting NSAID, with a relatively quick onset of action. Pain-relieving effects last for approximately four hours. Like acetaminophen, it is better suited for the treatment of acute pain. Ibuprofen tablets/capsules can be given every four to six hours. If you are taking ibuprofen over-the-counter, the maximum recommended daily dose is 1200mg. Do not take more ibuprofen than recommended without consulting your doctor.
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How Acetaminophen Is Used For Back Pain
Acetaminophen is sold in varying strengths without a prescription, including regular strength, extra strength, and arthritis pain formulas. While over-the-counter acetaminophen is often recommended to treat mild to moderate pain, a physician may recommend an acetaminophen-opioid combination in some situations, such as for severe pain or pain following back surgery.
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Warnings Of Acetaminophen Vs Ibuprofen
Acetaminophen is generally considered to be well tolerated. However, taking more than the recommended dose of acetaminophen can increase the risk of liver damage. Acetaminophen is known to be hepatotoxic or toxic to the liver in high doses.
Ibuprofen is more likely to cause gastrointestinal and cardiovascular adverse effects than acetaminophen. Like all NSAIDs, ibuprofen use can increase the risk of stomach ulcers, especially in people who have a history of peptic ulcer disease. Taking ibuprofen can also increase the risk of heart attack and stroke, especially in those with a history of heart problems or high blood pressure. Ibuprofen should be avoided to treat pain before, during, or after coronary artery bypass graft surgery.
One study found that acetaminophen can cause NSAID-related adverse effects in higher doses over time. These adverse events include ulcers, heart attack, and stroke in some people who are predisposed to these events.
Acetaminophen may be considered safer than ibuprofen for pregnancy. However, these drugs should only be taken during pregnancy if the benefits outweigh the risks. Taking acetaminophen or ibuprofen may cause premature closure of the ductus arteriosus in babies.
Which Painkiller Should You Pick
So which pain med reigns supreme? While theres no right answer, these pointers can help you decide.
Fever
Most research suggest acetaminophen and ibuprofen have similar results in controlling fevers, so pick what works for you.
Stomach trouble
If you have a sensitive stomach or find that ibuprofen causes heartburn or nausea, give acetaminophen a whirl.
Period pains
Ibuprofen reduces your bodys production of prostaglandins. These are the chemicals that trigger the uterus to contract and start periods each month. Ibuprofen can ease menstrual cramps and may also make menstrual bleeding lighter.
Other meds
Both ibuprofen and acetaminophen can interact negatively with some prescription and over-the-counter drugs. If youre taking medication, talk to your provider doctor or pharmacist before reaching for the painkillers.
Persistent pain
If youre taking painkillers over several days, consider alternating ibuprofen and acetaminophen to lower the risk of side effects.
Kids
Both ibuprofen and acetaminophen can control pain in kids. But ibuprofen tends to work better as a fever reducer. Be sure to follow the dosage guidelines on the label for your little ones age and weight.
Whats the takeaway? When used responsibly, ibuprofen and acetaminophen are safe choices for turning down the dial on fever and pain. And isnt it good to have options?
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Aleve Is More Likely To Cause Gastrointestinal Side Effects Because It Is Long Acting
Research has discovered that the risk of gastrointestinal side effects such as stomach ulcers and stomach bleeding increases the longer somebody takes NSAIDS. Aleve is more likely than ibuprofen to cause GI side effects because it is longer acting. To reduce the risk of GI side effects, NSAIDS should only be taken at their lowest effective dose, for the shortest possible time. Doubling up on NSAIDs is unnecessary, and to be avoided as it increases the risk of both GI and cardiovascular side effects. If you are prescribed low-dose aspirin to reduce your risk of a heart attack or stroke, then talk to your doctor BEFORE taking NSAIDs, as these may negate the protective effects of aspirin.
Which Is The Best Arthritis Cream For Back Pain
The active ingredient is menthol, which creates cooling sensations and temporary pain relief. It penetrates quickly to relieve pain on the back and all joints from the neck down to the ankle. The spray nozzle has continuous flow even when upside down to get those hard-to-reach aches. Three powerful pain fighters give this creamy oil a punch.
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How Tylenol Arthritis Works
Tylenol Arthritis contains two layersone that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water.
There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.
Acetaminophen is an analgesic, meaning it relieves pain. Acetaminophen is not an anti-inflammatory, so it does not ease swelling. For this reason, Tylenol Arthritis is best for osteoarthritis and not inflammatory types of arthritis such as rheumatoid, reactive, or gout.
Acetaminophen is thought to work by interfering with hormones called prostaglandins, reducing pain sensations within the nerve endings, nervous system, and brain.
Tylenol Arthritis can temporarily relieve other types of pain such as general aches, muscle soreness, toothache, menstrual cramps, aches due to cold and flu, and back pain. As with other acetaminophen-containing drugs, Tylenol Arthritis can also help reduce fevers.
Ibuprofen Or Naproxen Effectiveness For Back Pain
Ibuprofen or Naproxen belong to a class of drugs called NSAIDs that are first-line treatments for back pain. According to one study:
- The evidence from the 65 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic low-back pain without sciatica
Thus NSAIDs such as naproxen and ibuprofen are modestly effective for low back pain.
The doses you can try are:
- Ibuprofen 400mg to 600 mg four times daily or
- Naproxen 220mg to 440mg twice daily
You should take the dose on a scheduled basis rather than as needed for about 1 to 2 weeks. Taking an NSAID on a schedule basis for about 1 to 2 weeks will really decrease the inflammation in your back. After 1-2 weeks, you can take the NSAID on an as needed basis.
You do not want to take an NSAID like ibuprofen or naproxen longer than 2 weeks without the supervision of your doctor because these medications have lots of side effects if you take them constantly for a long time. The safety of NSAIDs shall be discussed below.
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When Do You Need A Doctor For Back Pain
if you have any of the following symptoms along with your back pain, see a doctor immediately:
- Numbness in an arm or leg
- Trouble with bowel or bladder control
- Weakness in an arm or leg
When the team assesses patients with severe back pain, we often recommend physical therapy and pain medication then we dont see the patients again because their back pain got better on its own. Staying or getting active with guidance from your doctor can provide ample relief for severe back pain.
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Is Tylenol Or Ibuprofen Better For Back Pain
Ibuprofen or Naproxen are better than Tylenol for back pain. In this article, you will learn how medical studies show that over-the-counter medications like ibuprofen or naproxen are more effective than Tylenol at relieving back pain.
About 84 percent of adults will have low back pain during their lifetime. You may be out gardening, you bend over to pick up that flower that youve been wanting to prune for a while, and now what happens is that your back flares up.
You should rest and ice the lower back to decrease the inflammation . If rest and ice are not enough to relieve the back pain, you may be wondering whether you should take Tylenol or ibuprofen for the pain as well.
In this article we shall be comparing the mechanism of action, effectiveness, side effects, and so much more between Tylenol and a group of pain relievers called NSAIDs which include ibuprofen and naproxen .
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When Should I See A Doctor
Acute low back pain is rarely due to any serious injury, disease or damage to the spine and does not cause lasting damage. But you should see your doctor if the pain doesnt improve over time or if you have any other unusual symptoms that worry you. Some examples are fever, difficulty passing urine, weakness, numbness or pins and needles in your legs.
Using Tylenol During Pregnancy
Providers have long told pregnant people that its safe to take Tylenol for minor aches and cold symptoms. However, research has now shown it might not be safe to take Tylenol while youre pregnant.
Experts now recommend that pregnant people avoid taking over-the-counter products that have acetaminophen in them because it might affect fetal development.
In certain cases, it might be OK for a pregnant person to take Tylenol if they have been told to by their provider.
Talk to your provider about the risks and benefits of taking Tylenol during pregnancy in your case.
If a pregnant person does need to take Tylenol, experts suggest taking the lowest dose for the shortest amount of time possible.
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