4 Things You Should Know If You Take NSAIDs for Chronic Back Pain
Back pain is the worst. And if you’re dealing with it on a regular basis, you’ve probably considered taking OTC non-steroidal anti-inflammatory drugs (NSAIDs). These medications—like ibuprofen and naproxen—are often the very first treatment doctors suggest if you have a problem like a herniated disc or sciatica, the super common nerve-related pain that can shoot through your butt and down your leg. The meds are also the go-to recommendation when the cause of the pain is unknown (which is the case for most people). Why? They’re cheap, relatively safe, easy to get a hold of, and, well, they’re pretty effective.
As life-changing as these drugs can be (a lot of people find they’re the only thing that eases their aches), they aren’t cure-alls. And if misused, they can trigger some pretty gnarly side effects. While it’s definitely okay—and common!—to take NSAIDs for long-term back issues, it’s best to do so armed with knowledge and, in some cases, under the guidance of a doctor. Here’s all the stuff you should know about these OTC pain relievers and how to stay safe if you’re taking them regularly.
1. It’s best to take them before you’re in total agony.
When you have a back problem, your body releases hormone-like substances called prostaglandins that try to heal your damaged tissues, a nurse practitioner specializing in treating pain. While this can be helpful, it also triggers a lot of inflammation. NSAIDs stop your body from making prostaglandins, which curbs swelling and pain. This is why ibuprofen works best when you take it 30 to 45 minutes before doing things that may make you feel worse, like yard work or physical therapy. “It’s better to take it preemptively than catch up afterward,” says the nurse. It basically gives them a chance to kick in so they can stop the flow of prostaglandins before they’re everywhere.
Of course, if you are like a lot of people, back pain may plague you around the clock. If you pop NSAIDs daily (which—if you are a healthy adult—is most likely safe to do for up to 10 days to treat pain), try to do it at the same time each day to ensure you consistently have enough meds in your system. (Ideally, this would also be about 30 to 45 minutes before activities that aggravate your back.) Having a routine will help you remember to take them too. And—this is key—pair them with food: Syncing up with your mealtime will protect your stomach and reduce your risk of ulcers, which are open sores in your GI tract that can cause burning stomach pain.
2. More isn’t always better.
If you take one thing away from this article, let it be this: If you wind up needing to take NSAIDs for a longer time, it’s important to have your doctor map out a dosing game plan. Why? The more of a drug you have in your system, the greater your risk of side effects, says the nurse. In general, it’s best to go with the lowest dose possible, then gradually increase it if your pain just won’t quit, she advises. (For ibuprofen and naproxen, the maximum dose is between 660 and 1200 mg in 24 hours, so check the label for the manufacturer’s instructions so you don’t go over it.) “Start low and go slow—just to minimize complications and risks,” says an assistant professor of physical medicine and rehabilitation.
Doctors occasionally recommend taking NSAIDs every day for more than 10 days (for example, up to six weeks) to see how well they fix your pain, says Dr. Habibi. You may find that your aches clear up in that window. But if not, depending on your health history, it might be okay to keep taking these meds two to three times a week until your symptoms improve, Dr. Habibi says. Otherwise, he doesn’t recommend taking OTC NSAIDs every day unless you’re closely working with a doctor who’s tracking your blood work and blood pressure to make sure the medications aren’t causing any issues.
3. Think twice before combining drugs.
You’ll also want to be careful when mixing NSAIDs with other things you are taking. According to the nurse, this can affect how well each of them works and increase health risks. For example, stomach bleeding is a big concern when you combine NSAIDs and blood thinners—which, as a general rule, Dr. Habibi says to avoid. Also, think twice if you are on proton pump inhibitors, which are commonly used to treat acid reflux; steroids, which are inflammation-fighting drugs; or diuretics and other high blood pressure meds. While the Dr. says it's not as dangerous to take these with ibuprofen or naproxen (compared to blood thinners), if you need to do so, then it’s a good idea to ping your doctor first. They may want to monitor your blood pressure and kidneys or give you a muscle relaxant or a topical anti-inflammatory gel, like diclofenac or trolamine salicylate, instead.
Another thing to be wary of? Mixing different types of NSAIDs. The Dr. says he commonly sees patients who take ibuprofen for back pain and aspirin for chronic heart and vascular issues. But popping two types of NSAIDs around the same time can increase your risk of stomach irritation or, more seriously, a GI bleed. Internal stomach bleeding can show up as bloody poop or vomit or present no symptoms at all but slowly and silently cause anemia, a condition where there aren’t enough healthy red blood cells to carry oxygen to your tissues. If you absolutely must mix different types of NSAIDs, talk to your doctor first, Dr. Habibi says.
4. They aren’t the best pain relievers for everyone.
Though NSAIDs might do wonders for your back, if you have a history of heart disease, stroke, ulcers, or gastritis, which is an inflammation of the stomach lining, you are more likely to have problems if you take them for a long time. If you’ve had any of these issues, it might be best to skip ibuprofen and naproxen altogether, only use them for a week or two, or opt for a prescription NSAID such as meloxicam or celecoxib. Dr. Habibi says the Rx versions may be easier for some people to tolerate. (Your stomach may thank you.) If you have any preexisting conditions, definitely ask your doctor what type of pain reliever you should take. They can also ensure you’re getting the most out of your NSAIDs—by, for example, finding the right dose for your situation and tracking how your body responds to it—while helping you dodge some of those risks.
If this sounds a bit scary, know that generally speaking, NSAIDs are pretty safe—it just requires some planning. When you take NSAIDs for back pain, the goal is to make a noticeable difference in your pain levels, the Dr. says. If they aren’t helping that much, it may be best to skip them. “If you’re taking them and not seeing any pain relief, it’s not worth the risks,” he says. Your doctor may offer another solution to make your back pain more manageable, such as physical therapy, prescription medications, or injections. But if NSAIDs make your life a little easier, that’s a big deal, Dr. Habibi points out.
They can absolutely be game changers, but these little pills pack a punch, so you just want to make sure you’re taking NSAIDs as intentionally—and safely—as possible.
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