Study Summary: Adding Second Pain Reliever To The Nsaid Provided No Significant Benefit
This double-blinded RCT enrolled 323 adult patients presenting to an ED with 2 weeks of nontraumatic, nonradicular LBP, which was defined as pain between the lower border of the scapulae and the upper gluteal folds. Participants had a score of > 5 on the Roland-Morris Disability Questionnaire , which measures functional impairment due to LBP . Patients were excluded if they had radicular pain radiating below the gluteal folds, direct trauma to the back within the previous month, pain duration > 2 weeks, or a recent history of > 1 LBP episode per month. Patients with current or past chronic opioid use were also excluded.
All participants received 10 days worth of naproxen . They were then randomized to receive either: oxycodone 5 mg/acetaminophen 325 mg cyclobenzaprine 5 mg or placebo, with instructions to take one to 2 tablets prn every 8 hours for 10 days. They were told that if one tablet afforded sufficient relief, there was no need to take the second one, but if the first tablet did not provide relief within 30 minutes, they should take the second one. All patients also received a 10-minute educational session emphasizing the role of exercise, stretching, physical/massage therapy, and other non-pharmacologic interventions.
Whats New: A Second Pain Reliever Adds Nothingexcept Adverse Effects
This RCT found that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen for the treatment of nontraumatic, nonradicular acute LBP did not significantly improve functional assessment based on RMDQ scores or pain measures at 7 days or 3 months after the initial ED visit. It did, however, increase adverse effects.
Why Pain Medicine May Not Work And What Will Relieve Your Pain
One of the reasons why research may find that NSAIDs do not work on back pain is due to discomfort related to sciatica. This is a type of pain caused by herniated discs or nerve issues. Since sciatica is not inflammatory, painkillers like Advil will not work well to relieve that pain.
If your back pain also shoots down one or both of your legs, it is likely nerve-related issues. It is vital to have your back pain checked out by your doctor or chiropractor so that you will better understand whether NSAIDs can help you or whether you should choose a different type of treatment.
Usually, sciatica pain goes away after several weeks or several months. During this time, however, your doctor can prescribe you oral steroids or physical therapy. If your back pain is found to be inflammatory instead of due to a sciatica, NSAIDs may provide some relief but not much. It may also not work for everyone.
If you want to relieve your back pain, you may want to take part in some lifestyle interventions and chiropractic treatments. Physical activity has been found to help relieve back pain. Specifically, exercise routines that strengthen the core of your body have been found helpful. Taking part in Pilates, where your abdominal muscles and obliques as well as spinal muscles are strengthened, is recommended.
Severe Side Effects Of Nonsteroidal Anti
If you have any of the following complications, it is crucial to seek medical attention or call your doctor right away. These include but are not limited to:
Severe abdominal pain
Any signs of bleeding, such as bloody or red-dark stools, blood in urine, vomiting blood or vomit that looks like coffee grounds, abnormal bloody vaginal discharge, bleeding gums, or any other persistent abnormal bleeding
Swelling of the face, eye area, lips, tongue, hands, ankles, or feet
Yellowing of the skin or whites of eyes
Red or irritated eyes
Skin abnormalities such as red, very dry, blistered, painful, or peeling skin
OTC pain medications are only one part of managing your pain. At Goodpath, we use a well-rounded approach that includes therapeutic exercise, nutritional support, and mind-body techniques like meditation or yoga. Start by taking our assessment to get your personalized program.
What’s The Difference Between Tylenol Advil And Aspirin Which Is The Best To Take For Pain
I used to take acetaminophen for the occasional headache or sore muscle, mostly because that’s what we used in my house growing up. I didn’t think much about whether it was more or less effective than any other type of over-the-counter pain reliever, and I suspect the same is true for many folks. Acetaminophen, after all, is the most popular over-the-counter painkiller worldwide.
So I was surprised when I found out there’s a huge gap between how pain researchers think about this drug and how the public does. More specifically, every researcher I contacted for this piece said some variation of what Andrew Moore, a pain researcher at Oxford University, told me: Tylenol doesn’t actually work that well for pain. To be more exact, he said, “I can’t imagine why anybody would take acetaminophen.”
Moore has done a number of systematic reviews on over-the-counter pain medications, looking at all the available evidence to figure out which ones work best for various problems. I asked him to describe the overall success rates for the most common three: acetaminophen , ibuprofen , and aspirin.
Now, Moore was referring here to acute pain that strikes after a specific event, like a surgery, a cut, or a burn, but his message was simple: Ibuprofen seems to work best, followed by acetaminophen, and then aspirin.
For ongoing pain a sore lower back, say, or the kind of degenerative arthritis that typically develops with age ibuprofen still outperforms acetaminophen.
Other Articles In This Acute Low Back Pain Treatments Series
While erythematosus or urticarial skin rashes are occasionally observed, the most serious adverse affect of acute acetaminophen over dosage is hepatotoxicity . In adults, hepatotoxicity may result from a single dose of 10 to 15-grams. More chronic abuse of acetaminophen has been associated with nephrotoxicity .
Acetaminophen’s analgesic effects make it an acceptable medication in the treatment of acute low back pain. It is inexpensive and its use is typically without complications. While effective against mild to moderate pain in some acute back pain situations, it does not offer the patient other desirable effects against inflammation, muscle spasm, nor sleep disturbance. Its efficacy as an analgesic for low back disorders associated with severe pain is more questionable.
Does Advil Make Lower Back Pain Worse
Have you ever taken an Advil or another non-steroidal anti-inflammatory drug to treat severe back pain and found that it had little effect? Have you even found that Advil, which is a brand name for Ibuprofen, may make your lower back joint pain worse? If so, the research supports these outcomes among those with back pain.
It has been suggested that the anti-inflammatory action of NSAIDs like Advil can actually make back pain worse. However, pro-inflammatory activity such as exercise has been shown to relieve pain. Endogenous opioids such as endorphins are known to fight pain. These are natural brain chemicals that are produced during exercise and are known to enhance mood and reduce anxiety as well as alleviate pain.
In addition, research shows that drugs such as Advil are only as effective as a placebo. As such, NSAIDs do not offer any significant benefit and it is necessary to find ways for patients to stop taking such medication due to its potential risks.
There are numerous side effects that ibuprofen or Advil entails. The most common of these side effects includes the following.
- Nausea and vomiting
- Constipation or diarrhea
Most importantly, a comprehensive review has found that people who take ibuprofen such as Advil have seen little more benefit than a placebo for treating back pain. This finding is based on 35 peer-reviewed trials looking at NSAIDs for alleviating discomfort in the back.
What Is Aspirin What Symptoms Does Aspirin Treat
Aspirin is the most different from the products above. It is considered an analgesic , a NSAID , and an antiplatelet agent. Antiplatelet agents work by preventing blood cells from sticking together, so it can help reduce blood clots. Aspirin is recommended for ages 12 and up. There is a low dose tablet , and a high dose tablet . Although aspirin is used similarly to the above products, it is used more-so for heart conditions such as:
- Acute coronary syndrome
- Management of stable ischemic heart disease
Warning: Not appropriate for children under 12 years because of their risk of Reyes syndrome. Do not take the higher dosage on a daily basis because it can increase risk of stomach bleeding.
What Side Effects Do Nsaids Have
Most patients do not get major side effects when they take NSAIDs such as ibuprofen or naproxen for short term up to two weeks. However, you are at increased risk of side effects if you take NSAIDs for a long time or if you have medical problems such as a history of heart attack or stroke, kidney disease, or previous bleeding in your stomach or intestines that we discussed above . The most common side effects of NSAIDs are as follows:
- Heartburn: NSAIDs can cause heartburn and stomach upset. You should take an NSAID with food to minimize heartburn.
- Stomach ulcers or bleeding: If you are over 65 years old or take NSAIDs for a long time you may start to develop ulcers or bleeding in your stomach, esophagus, or intestines. Your doctor may recommend antacids such as omeprazole or lansoprazole to reduce the risk of developing a stomach ulcer or bleeding when you are taking an NSAID.
- Increased Blood Pressure: Your blood pressure may increase while taking an NSAID, but if you are taking blood pressure medications and your blood pressure is stable, NSAIDs probably will not affect your blood pressure that much.
- Kidney Disease: Avoid NSAIDs if you have kidney disease because NSAIDs can make your condition worse.
- Liver Disease: Although rare, taking NSAIDs for a long time may damage the liver. If you have to take NSAIDs for more than a month, your doctor may need to check your liver function with a blood test.
What Are The Best Prescription Muscle Relaxers
There are certain times when over-the-counter medications simply arent enough. If youve been taking acetaminophen or ibuprofen consistently but are still dealing with back pain, spasms, or other issues, it might be time for something more robust. In cases like these, doctors may look to prescription muscle relaxants as a more effective, albeit temporary, answer.
A pulled back muscle or neck pain may require a doctors visit or other diagnostic tests to get to the heart of the issue, Dr. Lewis says. There are several good prescription medications like methocarbamol, cyclobenzaprine, and metaxalone.
Recent studies have shown that skeletal muscle relaxants , or antispasmodics, outperform anti-inflammatory drugs , like ibuprofen and acetaminophen, in relieving severe pain associated with conditions like acute back pain. On the flip side, they also have potentially more serious side effects and shouldnt be used for long-term pain management. Even so, these prescription drugs are effective and reliable options for short-term pain relief:
How Do I Get Rid Of Sciatica Permanently
Typically, people affected with sciatica will experience symptoms on only one side of the body. Although the pain may be severe, sciatica can most often be relieved through physical therapy, chiropractic and massage treatments, improvements in strength and flexibility, and the application of heat and ice packs.
How Should I Lay With Sciatica
Lie flat on your backkeep your heels and buttocks in contact with the bed and bend your knees slightly towards the ceiling. Slide a pillow between your bed and knees for support. Slowly add additional pillows until you find a comfortable knee position. Its not uncommon to not find relief after a few days.
What Is The Dosage For Acetaminophen Vs Ibuprofen
- The dose for adults is 325 to 650 mg every 4 hours or 500 mg every 8 hours when using immediate release formulations.
- The dose for extended release caplet is 1300 mg every 8 hours.
- The maximum daily dose is 4 grams.
- The oral dose for a child is based on the child’s age and weight. If less than 12 years old the dosing is 10-15 mg/kg every 6-8 hours not to exceed 2.6 g/day . If older than 12 years of age the dose is 40-60 mg/kg/day every 6 hours not to exceed 3.75 g/day .
- For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to 6 hours.
- Arthritis is treated with 300 to 800 mg 3 or 4 times daily.
- When under the care of a physician, the maximum dose of ibuprofen is 3.2 g daily. Otherwise, the maximum dose is 1.2 g daily.
- Individuals should not use ibuprofen for more than 10 days for the treatment of pain or more than 3 days for the treatment of a fever unless directed by a physician.
- Children 6 months to 12 years of age usually are given 5-10 mg/kg of ibuprofen every 6-8 hours for the treatment of fever and pain. The maximum dose is 40 mg/kg daily.
- Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3-4 divided doses.
- Ibuprofen should be taken with meals to prevent stomach upset.
Is A Hot Shower Good For Sciatica
While patients often say theyre successful in alleviating the pain from sciatica with a heating pad or hot shower, this isnt the right approach. Why? Youre only temporarily relieving your pain symptoms because the heat causes fluid to build up, as well as more inflammation, that will eventually make pain worse.
What Are Your Options
If you try acetaminophen for a backache and it doesn’t work as well as you need it to, then stop taking it, says Dr. Katz. “Three to five days is all you need to find out if it will work.”
Also, you don’t necessarily have to choose between acetaminophen and NSAIDs you could try both at the same time. “They are often used in combination, because they don’t appear to have additive side effects, while many people find that they have additive benefits,” Dr. Katz says.
Finally, remember that pain relievers are just one tool available to men with back pain, whether occasional or chronic. Make sure to do all the other things mentioned above to recover from or prevent future flare-ups.
Is Acetaminophen Good For Anything
If the research community seems to have sided with ibuprofen for pain, is acetaminophen good for anything?Yes. There are some groups of people with health complications who shouldn’t take ibuprofen. For example, patients with kidney, gastric, cardiovascular, or bleeding problems may need to avoid NSAIDS like ibuprofen, so doctors might suggest Tylenol in these cases. There’s also some evidence that NSAIDS may increase the risk of psychosis and cognitive impairment in the elderly, so doctors may avoid prescribing these drugs for older patients. And Tylenol is generally considered safer than Advil or aspirin for pregnant women.Fever is another area where acetaminophen can help, said Moore. According to one systematic review, acetaminophen seems to be safe for treating very young kids with fever, and you can give children as young as 3 months old acetaminophen, whereas you need to wait until kids are at least 6 months old to safely treat them with ibuprofen. This may help to explain the popularity of drugs like Tylenol for kids.
But a final caveat here: If your child is older than 6 months, it’s not all that clear that acetaminophen outperforms ibuprofen for reducing fevers, and the same is true for adults. So keep that in mind the next time you confront your medicine cabinet.
How Well Do They Work
Cyclobenzaprine is the best studied of the muscle relaxants. In more than 20 studiesmost of which involved people with back or neck pain and lasted for two weekscyclobenzaprine was consistently more effective than placebo on various measures of pain relief, functional ability, and muscle spasm.
One analysis of 10 studies of people who took cyclobenzaprine compared with people who took a sugar pill to treat back or neck pain found that after 10 to 21 days, people with either types of pain who took cyclobenzaprine said their pain was reduced by about one point on 10-point pain or function scale, compared with those who took a placebo.
Carisoprodol and orphenadrine have been studied less, with only four trials for each drug. Both drugs appear to be more effective than placebo for relieving pain due to spasms.
There is not enough good quality research on the other medicationschlorzoxazone, metaxalone, and methocarbamolto determine how well they relieve pain.
There are few high quality studies that have compared one muscle relaxant against another, so we cant determine whether any one muscle relaxant is a standout. There is also not enough research to know if pills that combine a muscle relaxant with another drug, such as aspirin, codeine, or caffeine, are any more effective than a muscle relaxant alone.
Birth Control For Period Cramps
When you have period cramps you just can’t seem to relieve with the methods mentioned above, your doctor may prescribe birth control, which provides your body with hormones that may reduce your menstrual cramping. Talk to your doctor about your birth control options. They include birth control pills, injections, a patch, or an intrauterine device. Such a wide array of birth control options are available that there should be something that will work for your lifestyle and individual needs. Just make sure to let your doctor know youre hoping to find a birth control option that will provide relief from your menstrual cramping.