NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Non-steroidal anti-inflammatory medications (NSAIDs) treat both pain and inflammation. Inflammation is a contributing factor in most back and neck pain conditions, so reducing inflammation often helps alleviate the pain.

See Medications for Back Pain and Neck Pain

NSAIDs are available in over-the-counter and prescription strength. They can be used to address short-term back, neck, and muscle pain.

NSAIDs are also used to treat chronic pain, though—as with many drugs—side effects may appear over time. Research also suggests that NSAIDs may lose some of their effectiveness for people who take them every day for several weeks or months.¹

See Pain Management for Chronic Back Pain

NSAIDs for Back Pain and More

Common uses for NSAIDs include treatment for:

• Mild or moderate back pain, tenderness, inflammation, and stiffness
• Activity-related pain or discomfort, such as pain that follows sports, housework, shoveling snow, or other exertion
• Pain related to muscle strain in the low back and elsewhere
• Neck stiffness related to muscle, ligament, or tendon strains or damage
• Osteoarthritis joint pain
• Post-surgical pain

NSAIDs are also used for a number of other conditions, ranging from acute headaches to ankylosing spondylitis.

How NSAIDs Work

NSAIDs are a large class of drugs that work by reducing the body’s production of chemicals called prostaglandins, which trigger inflammation, fever, and pain.

Prostaglandins have other effects in the body, too. They help maintain the mucosal lining of the stomach and intestines, promote blood clotting, and help the kidneys function normally.

Because prostaglandins have many roles in the body, taking NSAIDs to suppress the production of prostaglandins can have both positive and negative effects.

Most Common Types of NSAIDs

There are many types of non-prescription (over-the-counter) and prescription NSAIDs. The four NSAIDs most often used to treat back and neck pain are:

• Aspirin (Bayer, Bufferin, and Ecotrin, St. Joseph). In addition to treating pain, fever, and inflammation, Aspirin may also reduce the risk of a heart attack. It is available over the counter and sometimes by prescription.
• Ibuprofen (Advil, Motrin). Ibuprofen can treat a range of conditions including post-surgical pain and pain from inflammatory diseases, such as ankylosing spondylitis. It is available over-the-counter and by prescription.
• Naproxen (Aleve, Anaprox DS, Naprosyn). Naproxen is commonly used to treat back pain, strained muscles, and low back pain. It is available over-the-counter and by prescription.
• Celecoxib (Celebrex). Celecoxib is most often used to treat pain caused by different forms of arthritis, including spinal osteoarthritis and rheumatoid arthritis. It is available by prescription.

See About Celebrex (Celecoxib), a COX-2 Inhibitor

Other Forms of NSAIDs

In addition to the above, NSAIDs come in forms other than those taken by mouth. For example:

• Ketorolac can be given as an intravenous, intramuscular, or intranasal drug (SPRIX), making it useful after surgery or if the patient cannot eat.
• Diclofenac is available topically as a gel (Voltaren), patch (Flector), or solution (Pennsaid). The medication is applied directly to the area of pain. Topical forms reduce gastrointestinal and other potential side effects of NSAIDs.

While these forms of NSAIDs are available in certain situations, NSAIDs are most commonly taken by mouth.

See Trouble Swallowing Pills (Dysphagia)

Taking NSAIDs Safely

NSAIDs should be used cautiously when taken for more than a few days in a row. People are advised to:

• Check with a health care professional. Because NSAIDs have risks and complications, it is important to keep a health care professional informed. People taking NSAIDs for long periods are advised to see a doctor regularly so any side effects can be monitored. In some cases, a change in medication may be required.
• Do not exceed maximum daily dose. This information is often available on the label or packaging along with guidelines for taking the medication.
• Use as little as possible. The U.S. Food and Drug Administration advises that the lowest effective dose of NSAIDs be used, and then for only as long as necessary.
• Alternate NSAIDs with acetaminophen. NSAIDs and the pain relief medication acetaminophen (Tylenol) work differently, so sometimes doctors recommend taking both medications. This often offers better pain relief than taking one type of pain medication. Some people find alternating between the two types of medications helps lessen the pain as one dose wears off—for example, taking a dose of ibuprofen, then 3 hours later taking a dose of acetaminophen.

See Acetaminophen for Back Pain

Any adverse reactions from taking an NSAID, or any other medication, should be reported to the doctor without delay.

When NSAIDs Are Not Advised

People having a lumbar fusion surgery are typically advised not to take NSAIDs for at least 3 months after surgery due to concerns about the impact NSAIDs may have on bone healing.

See Postoperative Care for Spinal Fusion Surgery

NSAIDs are also not advised for people who are taking anticoagulant medication (blood thinners) or who have kidney disease.

Many doctors also tell patients to stop using NSAIDs prior to other types of surgery because the medication poses an increased risk of bleeding.