Harvard Men's Health Watch

Best bets for back pain

Judicious use of pain relievers can help you keep doing your usual daily activities, which aids recovery from back pain.

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When your back is bothering you and you don't want to take prescription drugs, over-the-counter solutions and physical therapies can help relieve symptoms.

At this moment, about 10% of men have a backache, and up to 90% will have a backache at some point in their lives. Most flare-ups of low back pain get better over time, often within a few weeks. Pain control is important because it allows you to stay active, which assists in your recovery. For over-the-counter pain relievers, you have two options: acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).

But pain relievers are only one tool to help you recover from, and prevent, low back pain, according to Dr. Jeffrey N. Katz, professor of medicine and surgery at Brigham and Women's Hospital and editor of the Harvard Special Health Report Low Back Pain: Healing Your Aching Back. Dr. Katz suggests you also include these steps in your back-care plan:

Soothe with cold or heat. In the first few days, when pain is most intense and may be accompanied by inflammation, apply cold compresses for 15-minute periods. After a few days, switch to warm compresses to relax the affected muscles and enhance blood flow to the area. This simple approach can reduce reliance on pain relievers.

Stay as active as possible. Limited amounts of rest in a chair or bed can help when the pain is most intense, but you will do better in the long run if you keep doing your daily activities.

Stretch and strengthen your back. Once the pain eases, it's helpful to exercise regularly to stretch and strengthen the muscles that support your spine. This helps prevent future flare-ups. A physical therapist can offer individual advice.

Develop back-safe techniques. When you lift heavy objects, lift with your leg muscles—not your back. Watch out for behaviors, like slouching when you sit, that may trigger back pain.

Does Tylenol work?

During back-pain flare-ups, you may also need an over-the-counter pain reliever to help you through. Doctors often suggest you first try acetaminophen (Tylenol, others) because it is gentler on the stomach, even though NSAIDs tend to work better for back pain. There's good evidence that acetaminophen relieves headaches, dental pain, and pain after surgery, but its effectiveness for back pain is less well supported.

A recent research review in BMJ found only three clinical trials that directly compared acetaminophen to a placebo for back pain. The review pooled findings drawn from more than 1,800 participants. It found no evidence that acetaminophen relieved pain, reduced disability, or improved quality of life. An Australian study published in The Lancet—which provided 90% of the data in the BMJ review—found that the time to recover from backache was the same (about 17 days) whether study participants took acetaminophen or a placebo. In short, acetaminophen worked no better than a sugar pill.

It's important to keep in mind that these clinical trials measured the effect of acetaminophen in a diverse group of back-pain sufferers. All back pain isn't the same, and acetaminophen could be helpful in certain individuals. But the research suggests that you should not be too surprised if it doesn't work.

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.

Over-the-counter options

For over-the-counter pain relievers for back pain, you have two options: acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs).


Acetaminophen interferes with the pain process, although exactly how it does so is not fully understood. It also reduces fever, but it does not fight inflammation.

What are the risks? High doses of acetaminophen can damage the liver. The FDA-approved maximum daily dose for acetaminophen is 4,000 milligrams (mg), but many doctors suggest staying closer to 3,000 mg to create an extra margin of safety. "No drug is perfectly safe, but for people who don't have liver problems, I recommend acetaminophen fairly often," Dr. Katz says. Men who have liver disease or drink alcohol regularly should not take acetaminophen daily without consulting their doctors first.


The over-the-counter alternatives to acetaminophen are the NSAIDs ibuprofen (Advil, Motrin), naproxen (Aleve), and common aspirin. These reduce pain and fever as well as inflammation. "Over all, NSAIDs are more potent for pain relief," Dr. Katz says.

What are the risks? The most common side effects of NSAIDs are stomach pain, nausea, heartburn, and diarrhea. Less common but more dangerous are ulcers and gastrointestinal bleeding. Some research has linked NSAIDs to heart problems, so people with cardiovascular disease are advised to avoid prolonged use. NSAIDs also may cause kidney damage, though this is uncommon.