These Are the Best Medications for Low Back Pain, According to New Research

woman back pain
Study: Acetaminophen May Not Help Back Painboonchai wedmakawand - Getty Images
  • New research finds common treatments for low back pain aren’t necessarily effective.

  • Those medications include acetaminophen and muscle relaxers.

  • Experts recommend a slew of other treatments to help manage pain.

Back pain is one of the leading causes of disability worldwide, according to the World Health Organization (WHO), but treating it can be tricky. After all, what works for one person may have little effect on someone else.

Still, there are mainstays of back pain treatment, including using muscle relaxers, acetaminophen, and, in more severe cases, narcotics. But new research suggests that those methods of treating back pain may not be the best.

The meta-analysis, which was published in the BMJ, looked at data from 98 randomized controlled trials of more than 15,000 with back pain who tried 69 different medications or combinations of medications. Those included non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, muscle relaxants, and corticosteroids, among other things.

The researchers measured low back pain intensity at the end of treatment (it was an average of 65 out of 100 in the beginning), along with the safety of the medications. At the end of the study, researchers found that there was low or very low confidence in evidence to show that a slew of common medications used to treat low back pain actually work when compared to a placebo. Those medications included the muscle relaxant tolperisone, anti-inflammatory drug aceclofenac plus muscle relaxant tizanidine, anti-convulsant drug pregabalin, muscle relaxant thiocolchicoside, and anti-inflammatory drug ketoprofen. Medications like ibuprofen and acetaminophen also only showed moderate reductions in pain.

The researchers also noted that some of these medications could cause side effects like nausea, vomiting, drowsiness, dizziness, and headache.

“Our review of analgesic medicines for acute non-specific low back pain found considerable uncertainty around effects for pain intensity and safety,” researchers concluded. Because of this, they recommend that healthcare providers and patients “take a cautious approach to the use of analgesic medicines.”

Given how common low back pain is, it’s understandable to have questions. Experts explain the study’s findings and recommend alternative pain treatments.

Why might common medications be ineffective against low back pain?

It’s important to point out that this isn’t the first time research has found that several of these medications were ineffective or not the best at helping with low back pain.

Another meta-analysis published in the BMJ in 2021 analyzed data from 31 randomized controlled trials involving more than 6,500 people and found that muscle relaxants were largely ineffective for treating back pain. The researchers specifically determined that, while muscle relaxants may help reduce pain in the short term, it has a small effect on pain and comes with an increased risk of side effects.

The American College of Physicians (ACP) also said in clinical guidelines released in the Annals of Internal Medicine that research has shown that acetaminophen (Tylenol) is not effective at reducing back pain compared to a placebo and that there is “low-quality evidence” that corticosteroids effectively treat back pain.

Jamie Alan, Ph.D., an associate professor of pharmacology and toxicology at Michigan State University, says she’s “not very surprised” by the latest study findings. “We have a poor understanding of pain,” she says. “Counseling is also important when recommending these medications, as is follow-up—both of which could be improved on.”

It’s important to note that back pain can generally be divided into two camps—acute, which is a shorter episode of pain, and chronic, which is pain that persists, says Neel Anand, M.D., an orthopedic surgeon and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles. “Most people have chronic back pain,” he says. In those cases, “medications don’t treat the problem. It’s just symptomatic relief, but it’s not treating the cause,” Dr. Anand says.

What to do if you have low back pain

The ACP offers up the following as potential first-line solutions if you struggle with low back pain:

  • Yoga

  • Heat (like using a heating pad)

  • Exercise

  • Acupuncture

  • Massage therapy

  • Low-level laser therapy

  • Cognitive behavioral therapy

  • Spinal manipulation

The ACP recommends trying the above first before moving on to medication if these treatment methods aren’t effective. Physical therapy, where a practitioner can help with spinal manipulation, biofeedback, and stretching, can also be helpful, Alan says. Justin J. Park, M.D., a board-certified orthopedic spine surgeon with The Maryland Spine Center at Mercy Medical Center in Baltimore, also recommends physical therapy for back pain. “It can help strengthen the core muscles that support the spine, along with back extensor muscles,” he says.

Wearing supportive sneakers around the house, and while you’re out and about may help as well, Dr. Park says.

If you have an acute episode of back pain, like you pulled a muscle, medications like muscle relaxants and anti-inflammatories may help, Dr. Anand says. “But if you have chronic back pain, you need to find out what’s causing your pain so you can treat it better,” he says.

Worth pointing out: The ACP specifically notes that most back pain gets better over time, regardless of which treatment you use, and even encourages healthcare providers to tell their patients this.

When to see a doctor for low back pain

While you can try certain treatment options at home, it’s a good idea to consult a doctor under specific circumstances, Alan says. That includes having pain that’s persistent or getting worse after seven to 10 days, she says—and Dr. Anand says you’ll definitely want to see a back specialist if you’ve had pain for more than four weeks.

But, if you have changes in bladder or bowel continence, or numbness or weakness in your limbs, “contact your doctor immediately,” Alan says.

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