Top 3 Over-the-Counter Remedies for Back Pain (Plus a Fourth)

Among the array of over-the-counter medications for back pain, the most effective and widely embraced categories include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). 

While adhering to recommended usage guidelines typically ensures their safety, a minor potential for side effects and complications does exist.

This blog post breaks down the top over-the-counter (OTC) products for relieving musculoskeletal pain and inflammation, and the pros and cons of each one.

1. Acetaminophen (Tylenol)

Acetaminophen provides adequate relief from mild to moderate pain and fever that is not caused by inflammation. ¹ Gerriets 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/

The standard adult dosing is based on the intensity of pain and the strength of the medication ² Tylenol Regular Strength. Package Insert. Johnson & Johnson Consumer Inc; 2023 ^{, 3} Tylenol Extra Strength. Package Insert. Johnson & Johnson Consumer Inc; 2023 ^{, 4} Tylenol 8HR. Package Insert. Johnson & Johnson Consumer Inc; 2023 :

• Regular strength: 1 to 2 doses (325 mg to 650 mg) every 4 to 6 hours 
• Extra strength: 1 to 2 doses (500 mg to 1000 mg) every 6 hours 
• Extended-release formulas: 1 to 2 doses (650 mg to 1,300 mg) every 8 hours 

The maximum daily dose for adults is 3000 mg per day (six 500 mg tabs). ¹ Gerriets 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/

If you have liver disease or consume more than 3 alcoholic drinks per day, the maximum dose is even lower (2000 mg per day) due to the increased risk of liver damage. ¹ Gerriets 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/

Pros and cons of using acetaminophen

Acetaminophen is a go-to medication for most people, but there are some important considerations, including ¹ Gerriets 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/ ^{, 2} Tylenol Regular Strength. Package Insert. Johnson & Johnson Consumer Inc; 2023 :

• Pros: 
  • Minimal stomach irritation
  • Low risk of bleeding
  • Safe for use in kids
• Cons: 
  • No anti-inflammatory effects
  • Potential liver damage

Acetaminophen is also considered the safest OTC option for older adults and pregnant women. ¹ Gerriets 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/

Read more about Acetaminophen for Back Pain

2. Ibuprofen (Advil and Motrin)

Ibuprofen is an NSAID that relieves mild to moderate pain, inflammation, and fever. ⁵ Ngo VTH, Bajaj T. Ibuprofen. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542299/

• The standard dosing schedule for adults is 1 to 2 doses (200 mg to 400 mg) every 4 to 6 hours, as needed. ⁶ Motrin IB. Package Insert. Johnson & Johnson Consumer Inc; 2023
• The maximum daily dose of OTC ibuprofen for adults is 1,200 mg per day. ⁶ Motrin IB. Package Insert. Johnson & Johnson Consumer Inc; 2023

In older adults or people with impaired kidney function, it is recommended to use the lowest effective dose for the shortest possible time due to an increased risk of adverse events, such as stomach ulcers, bleeding, and kidney damage. ⁵ Ngo VTH, Bajaj T. Ibuprofen. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542299/

Pros and cons of using ibuprofen

Ibuprofen is one of the most commonly recommended OTC medications for back pain, but its use is not without limitations ⁵ Ngo VTH, Bajaj T. Ibuprofen. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542299/ ^{, 6} Motrin IB. Package Insert. Johnson & Johnson Consumer Inc; 2023 :

• Pros: 
  • Targets the cause of pain (inflammation)
  • Safe for use in kids when used as recommended
• Cons: 
  • Short duration of action (4 to 6 hours)
  • Potential for serious adverse events 

It is also important to note that due to a potential risk of harm to the developing fetus, NSAIDs are not recommended for pregnant women in their second or third trimester. ⁶ Motrin IB. Package Insert. Johnson & Johnson Consumer Inc; 2023 ^{, 7} US FDA Drug Safety Communication. FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid. https://www.fda.gov/media/142967/download (Accessed on July 27, 2023)

See Potential Risks and Complications of NSAIDs

3. Naproxen (Aleve)

Naproxen is an equally effective NSAID as ibuprofen but provides longer-lasting pain relief. 

The adult dosing schedule for naproxen is ⁸ Aleve Back and Muscle Pain. Package Insert. Bayer HealthCare LLC; 2022 :

• First dose: 220 mg 
• Second dose: 220 mg 1 hour after the first dose, if pain persists
• Third dose: 220 mg 8 to 12 hours after the second dose

No more than 3 doses (660 mg) should be taken within a 24-hour period. ⁸ Aleve Back and Muscle Pain. Package Insert. Bayer HealthCare LLC; 2022

Pros and cons of using naproxen

Naproxen may be similar to ibuprofen, but there are some key differences ⁹ Brutzkus JC, Shahrokhi M, Varacallo M. Naproxen. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525965/ :

• Pro: less frequent dosing (every 8 to 12 hours)
• Con: higher risk of kidney damage

Drinking a full glass of water with each dose of naproxen is recommended to prevent kidney injury. ⁸ Aleve Back and Muscle Pain. Package Insert. Bayer HealthCare LLC; 2022

Read more about Common NSAIDs for Back and Neck Pain

4. Magnesium salicylate tetrahydrate (Doan’s)

Magnesium salicylate is a less commonly known NSAID that is as effective for back pain as ibuprofen and naproxen. However, it is associated with a higher risk of bleeding. ¹⁰ Arif H, Aggarwal S. Salicylic Acid (Aspirin) [Updated 2023 Apr 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519032/

• This medication is only available under the brand name Doan’s Extra Strength tablets. ¹¹ Doan’s Extra Strength. Package Insert. Dr. Reddy's Laboratories Inc; 2016
• The recommended dosing is 1 to 2 doses (580 mg to 1,160 mg) with a full glass of water every 6 hours, as needed. ¹¹ Doan’s Extra Strength. Package Insert. Dr. Reddy's Laboratories Inc; 2016

The maximum daily dose of magnesium salicylate for individuals aged 12 and over is 4,640 mg (8 doses) per day. ¹¹ Doan’s Extra Strength. Package Insert. Dr. Reddy's Laboratories Inc; 2016

Decoding the differences between the types of OTC pain pills

While there may only be a few pain medications available over the counter, the number of formulations can be overwhelming. Deciding between coated tablets or liquid gels can be tough when all you need is pain relief.  

Here is a breakdown of the main differences ¹² USP. Pharmaceutical Dosage Forms . In: USP-NF. Rockville, MD: USP; Jan 2, 2023. :

• Liquid gels contain a liquid form of the medication inside a gelatin shell that is absorbed quickly and provides fast pain relief. They are also easier to swallow than traditional solid tablets.
• Rapid-release capsules have microscopic holes in the capsule shell that release medication quickly for a rapid onset of action.
• Gel caps are solid tablets covered by a gelatin coating. They are easier to swallow and less likely to cause an upset stomach.
• Coated tablets and caplets contain a solid form of the active ingredient inside a protective coating that helps prevent stomach irritation. These tablets take a little longer to dissolve and might take longer to start working.
• Extended-release medications are formulated to release some of the drug immediately and slowly release the rest for extended pain relief. 
• Dissolvable packets contain a powdered form of the medication in individualized dose packs that dissolve in the mouth. They do not need to be mixed with water. Acetaminophen is available as Tylenol Dissolve Packs and in combination with aspirin as BC Fast Relief Powder or Goody’s.

Understanding these distinctions will help you make an informed choice and eliminate confusion in the pharmacy aisle.

Choosing an OTC pain medication

You may be wondering which medication has the strongest pain-relieving effects, but the answer is not quite that simple and it depends on what is causing your pain.

Back pain usually involves injury and inflammation, so NSAIDs are typically preferred, but that does not mean they are always the best option. ¹³ Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/

Underlying medical conditions, age, and other medications impact which OTC product will provide effective pain relief while minimizing the risk of side effects and complications. ¹³ Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/

Read more about Medications for Back Pain and Neck Pain

Taking Tylenol and Advil (or Motrin) together or alternately to optimize pain relief

Dual therapy with acetaminophen and ibuprofen is an effective option for treating moderate to severe pain without having to get a prescription-strength pain reliever. 

• You can take the two drugs together at low doses every 4 to 6 hours ¹⁴ Thybo KH, Hägi-Pedersen D, Dahl JB, et al. Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial. JAMA. 2019;321(6):562-571. doi:10.1001/jama.2018.22039 ^{, 15} Abushanab D, Al-Badriyeh D. Efficacy and Safety of Ibuprofen Plus Paracetamol in a Fixed-Dose Combination for Acute Postoperative Pain in Adults: Meta-Analysis and a Trial Sequential Analysis. CNS Drugs. 2021;35(1):105-120. doi:10.1007/s40263-020-00777-7 :
  • One dose of acetaminophen (325 mg), and
  • One dose of ibuprofen (200 mg)
• You can alternate the drugs by taking 1 to 2 doses of the first medication and then 1 to 2 doses of the second medication 3 hours later. ² Tylenol Regular Strength. Package Insert. Johnson & Johnson Consumer Inc; 2023 ^{, 6} Motrin IB. Package Insert. Johnson & Johnson Consumer Inc; 2023  For example:
  • Take acetaminophen (325 mg to 500 mg), then 
  • Take ibuprofen (200 mg to 400 mg) 3 hours later
  • Continue to alternate every 3 hours

Combining the two medications targets pain through two distinct modes of action (pain perception and inflammation), which produces a stronger pain-relieving effect than taking only acetaminophen or ibuprofen. ¹³ Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/ ^{, 14} Thybo KH, Hägi-Pedersen D, Dahl JB, et al. Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial. JAMA. 2019;321(6):562-571. doi:10.1001/jama.2018.22039

However, combining NSAIDs (ibuprofen, naproxen, and magnesium salicylate) with other NSAIDs is not recommended due to the significantly increased risk of adverse events and complications. ⁵ Ngo VTH, Bajaj T. Ibuprofen. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542299/

Combination OTC products on the market

Some medications are preformulated with acetaminophen and ibuprofen, including: 

• Advil Dual Action
• Motrin Dual Action with Tylenol

These combination products contain 250 mg of acetaminophen and 125 mg of ibuprofen in each tablet. You can take 1 to 2 doses every 8 hours. ¹⁶ Motrin Dual Action With Tylenol. Package Insert. Johnson & Johnson Consumer Inc; 2023 ^{, 17} Advil Dual Action With Acetaminophen. Package Insert. GlaxoSmithKline Consumer Healthcare Holdings (US) LLC; 2022

Long term use of OTC pain medications 

When using OTC products for self-medication, using these medications for longer than 10 days is not recommended without consulting a healthcare provider to address the underlying cause. ² Tylenol Regular Strength. Package Insert. Johnson & Johnson Consumer Inc; 2023 ^{, 6} Motrin IB. Package Insert. Johnson & Johnson Consumer Inc; 2023 ^{, 8} Aleve Back and Muscle Pain. Package Insert. Bayer HealthCare LLC; 2022

It is also important to talk to a doctor if your back pain is severe, persistent, or accompanied by other concerning symptoms, such as numbness or weakness, which may indicate a more severe underlying condition.