Medications for Back Pain and Neck Pain (part 2)

Acetaminophen is probably the single most effective non-prescription medication for lower back pain and neck pain and generally has the fewest side effects. Tylenol is an example of a well-known brand name medication that has acetaminophen as its active ingredient, and most pharmacies sell generic versions of acetaminophen as well.

Unlike aspirin and non-steroidal anti-inflammatory drugs, acetaminophen does not have an anti-inflammatory effect. Instead, it relieves pain by working centrally (in the brain) to switch off the perception of pain. Up to 1,000 mg of acetaminophen may be taken every four hours, up to a total of 4,000 mg within 24 hours.

Potential Benefits of Acetaminophen

In addition to its efficacy, acetaminophen is frequently recommended because it has few side effects. Notably:

  • There is no chance of addiction with acetaminophen
  • Patients do not develop a tolerance (loss of pain relieving effect) with extended use of the medication
  • It does not produce gastrointestinal (stomach) upset
  • Very few patients are allergic to acetaminophen

Overview of Potential Risks of Acetaminophen

Importantly, acetaminophen is cleared through the liver so patients with liver disease should first check with their physician.

Patients should never take more than 1,000 mg every four hours (the maximum recommended dosage), as higher doses provide no additional pain relief and can harm the liver.

As with any medication, patients should read the acetaminophen package insert and note the potential risks and comply all of the instructions.

For severe episodes of low back pain or neck pain, narcotic pain medications (also referred to as opioids) may be prescribed. Clearly, narcotic agents are strong and potentially addictive forms of medication and should only be administered by a physician.

  • All narcotic agents have a dissociative effect that helps patients manage pain. It does not actually deaden the pain but works to dissociate patients from the pain. Commonly used narcotics, listed in ascending order of potency (strength) include:
  • Codeine (e.g. Tylenol #3)
  • Hydrocodone (e.g. Vicodin)
  • Oxycodone (e.g. Percocet, Oxycontin)

In general, narcotic medications can be highly effective in treating back pain for short periods of time (less than two weeks). After the initial two weeks, the body rapidly builds a natural tolerance to narcotic medications and they lose their effectiveness. While some physicians believe that narcotics can be used long-term at low doses to treat chronic pain, narcotics are most commonly used to treat severe acute (short-term) low back pain or post-operative pain.