Non-steroidal anti-inflammatory drugs (NSAIDs) are a popular class of medication that can help relieve back and neck pain. There are about 20 types of NSAIDs sold in the United States, but four dominate the market:

  • Aspirin
  • Ibuprofen
  • Naproxen
  • Celecoxib

See Medications for Back and Neck Pain

The strength of these medications varies. Typically, the prescription version is 2 to 4 times stronger than those sold over the counter. Prescribing doctors often give specific instructions on the medication dosage and schedule based on an individual’s situation; it is important to follow these directions carefully and not exceed the listed dose.

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Aspirin

Aspirin is available in several different strengths, ranging for 75 to 325 milligrams per tablet. People typically take aspirin in one of two ways.

  • Regular strength aspirin for pain. A typical regular strength aspirin has 325 milligrams per tablet. An adult may take aspirin every 2 to 4 hours for back, neck, or joint pain. People should not take more than 12 tablets (3,900 mg) in 24 hours.
  • Low-dose aspirin every day for heart attack prevention. While NSAIDs generally carry a higher risk for heart problems, aspirin is an exception. A typical low dose aspirin can reduce the clumping action of platelets in the bloodstream, which may help in preventing blood clots that cause a heart attack. For this reason, doctors often recommend that patients at risk for cardiovascular problems take a single low-dose aspirin each day.

People taking daily aspirin should be aware that using other NSAIDs at the same time can block aspirin’s crucial anti-clotting ability and increase the risk of stomach bleeding. When aspirin is taken daily for the heart, it should be taken first thing in the morning, and no other NSAIDs should be taken for at least 1 or 2 hours afterward.

Aspirin should not be given to children under age 12 or to adolescents with chicken pox or flu symptoms because of the possibility of Reye syndrome. Ringing in the ears can occur in patients taking high doses.

Ibuprofen

Ibuprofen (Advil, Motrin) is most commonly recommended to relieve mild or moderate back pain and inflammation. In some cases, such as for people with certain types of arthritis, a doctor may suggest prescription ibuprofen for long-term use.

  • Over-the-counter ibuprofen ranges from 200 to 400 milligrams per tablet. The recommended dose for an adult with mild to moderate pain is up to 600 milligrams every 4 hours.
  • Prescription doses can be as high as 800 milligrams. A health care professional will often have dosage and timing recommendations based on a person’s medical history and condition.

The maximum dose for a 24-hour period is 3,200 mg—equal to four maximum adult doses. Ibuprofen can be dosed for children as young as 6 months old.

Naproxen

Naproxen (Aleve, Anaprox DS, Naprosyn) is often prescribed for people who have joint pain, swelling, and certain forms of arthritis, such as ankylosing spondylitis. It is also used to treat menstrual pain and other symptoms.

An analysis of multiple studies indicated that naproxen was associated with a lower risk of cardiovascular problems than other NSAIDs; however, the FDA has not found the evidence to be strong enough to note this difference on NSAID labels.2

Naproxen comes in two forms:

  • Naproxen sodium is sold over-the-the counter (Aleve) and with a prescription (Anaprox, Anaprox DS, Naprelan).
  • Naproxen base is slightly stronger than naproxen sodium on a milligram-per-milligram basis. It is only available with a prescription (EC-Naprosyn, Naprosyn).

The regular adult dose is one or two 220 mg pills taken within an hour. If pain relief is still needed after 8 to 12 hours, another pill may be taken. A maximum of three pills may be taken in 24 hours. Higher prescription dosages are available and may be prescribed by a doctor, depending on the patient’s situation. Older adults should use naproxen cautiously and take the lowest possible dose.

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Celecoxib

Celecoxib (Celebrex), is a type of NSAID called a COX-2 inhibitor. Unlike other NSAIDs, COX-2 inhibitors do not impair blood clotting, so they are considered safer for people taking blood-thinning medications, such as warfarin (Coumadin).

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

Available in 100 mg and 200 mg tablets, celecoxib is dosed once or twice daily with a maximum daily dose of 800 mg. Celecoxib is used for juvenile rheumatoid arthritis in children as young as 2 years old. Celecoxib is not recommended for those with sulfonamide, aspirin, or NSAID allergies or in those with certain cardiovascular or gastrointestinal risk factors.

See Potential Risks and Complications of Celecoxib

Individuals differ widely in how their bodies respond to medication. If the first medication tried doesn’t seem to have the desired effect, it may be necessary to try other kinds to get relief.

References

  1. FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. July 9, 2015
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