Common NSAIDs for Back and Neck Pain

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly advised as the initial treatment for addressing pain, inflammation, and/or restricted mobility symptoms linked to back pain and neck pain.¹van der Gaag WH, Roelofs PD, Enthoven WT, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for acute low back pain. The Cochrane Database of Systematic Reviews. 2020;4:CD013581. doi:10.1002/14651858.CD013581

Common NSAIDs Used to Treat Back and Neck Pain

Over-the-counter (OTC) and prescription NSAIDs used for treating musculoskeletal back and neck pain include:

• Ibuprofen (Motrin, Advil)
• Naproxen (Aleve)
• Diclofenac (Voltaren)
• Meloxicam (Mobic)
• Celecoxib (Celebrex)

The selection of medication is based on individual factors such as other medical conditions, severity of pain, cost, and personal preference.

Types of Back and Neck Pain Treated with NSAIDs

NSAIDs are useful for acute pain management from injury, overuse, or a flare-up of a chronic condition.

Common spinal conditions treated with NSAIDs include:

• Spinal osteoarthritis
• Muscle strain or pulled muscle injury
• Ligament sprain
• Bursitis or tendonitis
• Nerve pain from herniated or bulging discs
• Degenerative disc disease
• Ankylosing spondylitis
• Facet joint pain
• Polyarticular juvenile idiopathic arthritis

When NSAIDs are used for managing chronic pain, they are used in conjunction with other types of medication, such as acetaminophen or non-opioid analgesics, and non-drug therapies, such as heat therapy or massage, to reduce the total amount of NSAIDs taken over time and minimize the risk of adverse events.²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/

Duration of Treatment with NSAIDs for Back and Neck Pain

OTC NSAIDs provide adequate pain relief for most people. However, in cases of severe acute pain or chronic pain, a doctor may prescribe a higher dose for a short period of time or supervise the long-term use of NSAIDs at lower doses.

• Short-term NSAID use (3 months or less). High-dose NSAIDs treat moderate-to-severe pain from an acute injury, such as a sports injury, or in post-surgical pain management.³Celebrex. Package Insert. Pfizer Laboratories Div Pfizer Inc; 2021^,4Meloxicam. Package Insert. Lupin Pharmaceuticals, Inc; 2022
• Long-term NSAID use (over 3 months). Certain NSAIDs (Naprosyn and Indocin) help manage chronic pain conditions, such as spinal osteoarthritis, when used at lower doses.²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/

It is important to monitor for signs of serious adverse events to determine whether therapy with NSAIDs can be safely continued.

NSAID Alternatives for Treating Back and Neck Pain

If NSAIDs are unavailable or unsuitable, alternative over-the-counter products, prescribed medications, and non-drug therapies may be utilized for pain management. 

OTC medications 

Over-the-counter alternatives to NSAIDs for mild to moderate back and neck pain include⁵Tylenol 8 HR Arthritis Pain. Package Insert. Johnson & Johnson Consumer Inc; 2023^,6Barkin RL. The pharmacology of topical analgesics. Postgrad Med. 2013;125(4 Suppl 1):7-18. doi:10.1080/00325481.2013.1110566911:

• Oral acetaminophen (Tylenol)
• Topical lidocaine (Aspercreme)
• Topical menthol, camphor, and methyl salicylate (Icy Hot, Salonpas)
• Topical capsaicin (Capzacin)

It is important to note that OTC medications that do not contain an NSAID will not reduce inflammation.⁷Gerriets V, Anderson J, Nappe TM. Acetaminophen. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482369/

Prescription medications 

Prescription medications without NSAIDs that help reduce pain include: 

• Muscle relaxers (Soma, Valium, Zanaflex)
• Antidepressants (duloxetine)
• Anti-seizure medications (gabapentin and pregabalin)
• Corticosteroids (prednisone and methylprednisolone)
• Opioid analgesics (tramadol and hydrocodone)
• Hyaluronic acid injections

These medications have unique mechanisms of action, and it is important to consult with a doctor to determine which type of pain reliever will be effective based on the cause and intensity of pain.

See Medications for Back Pain and Neck Pain

Non-drug therapies for back and neck pain

Alternative strategies that are effective for back and neck pain address the underlying causes of pain, promote healing, and improve overall well-being include:

• Physical therapy for back pain and neck pain²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Cognitive behavioral therapy (CBT)²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Yoga and Pilates²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Massage therapy²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Heat and cold therapy²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Water therapy²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Stress management and mindfulness²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Ergonomic adjustments for improved posture²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Transcutaneous electrical nerve stimulation (TENS)²Lindsey T, Dydyk AM. Spinal Osteoarthritis. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK553190/
• Red light therapy (photobiomodulation)⁸Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys. 2017;4(3):337-361. doi:10.3934/biophy.2017.3.337

The effectiveness of these therapies is variable. It is advisable to consult with a doctor or qualified healthcare professional to determine which strategies are likely to provide the most benefit.