In the fight against back pain, many people and their doctors reach for the same weapons: common over-the-counter (OTC) and prescription medications. New research on three commonly recommended and prescribed medications has found that all three may be virtually ineffective against back pain and may actually do more harm than good.

Over-the-counter: Tylenol

Tylenol has been widely advertised all over the world as a catch-all OTC medication for aches and pains of every variety. From acute back pain to achy knees and chronic pain, advertisements would have you believe that Tylenol is effective and safe for pain. A new study published in March found that Tylenol’s claims of efficacy in the treatment of both back and knee pain were false.

A meta-analysis of randomized controlled studies focusing on Tylenol’s ability to relieve spinal pain and pain due to osteoarthritis found that for spinal pain, Tylenol showed no effect on pain in either short- or intermediate-term follow-ups. For osteoarthritis, the short-term efficacy of Tylenol for spinal pain was more pronounced than for intermediate use, but pain reduction was still rated as moderate. Any pain relief reported was clinically insignificant and similar to the placebo group. The studies included in the meta-analysis focused on just over 5,300 patients with back and knee pain and excluded any patients with previous surgeries for either condition.

While some patients suffering from chronic and acute back pain may find that any minor reduction in pain is worth the risk, the side effects may not be worth it. Since 2011, the Food & Drug Administration has required medications that use acetaminophen to carry a “black box” warning that highlights its risk for liver failure. Many who take Tylenol for pain do not realize that other medications (e.g. cold medicines) also contain acetaminophen. Exceeding the maximum daily dose by even a small amount can cause serious side effects and may even cause death. For anything other than acute, short-term pain, taking Tylenol is not recommended.

Prescription: Opioids

While the risks of opioids have been well-documented, a recent study by the American Academy of Pediatrics found that the use of prescription opioids is linked to fewer positive outcomes after spinal surgery. The study of just over 500 patients used patient reporting to measure health preoperatively and at three, six, and 12 months post-operatively. Differences in recovery, mental health, and decreased pain was significantly influenced by opioid use in the following ways:

  • Patients who increased opioid use before spinal surgery did significantly worse post-operatively at three and 12 months.
  • For every ten milligrams of increase in opioid use, the study found a significant decrease in mental and physical health scores.
  • Patients who also suffered from comorbid conditions such as depression and anxiety were more likely to take opioids.

Lead study author Clinton J. Devin, MD, assistant professor of orthopedic surgery and neurosurgery at the Vanderbilt Spine Center had this to say about the treatment implications of study’s findings:

“Our work highlights the importance of careful preoperative counseling with patients on high doses of preoperative opioids, pointing out the potential impact on long term outcome and working toward narcotic reduction prior to undergoing surgery.”

Even for those patients who choose not to undergo surgery, opioids have very little effect on chronic low back pain. While there seems to be some short-term analgesic benefit, the risk of dependence and other side effects likely outweighs the minimal benefit in intermediate- and long-term use.

Prescription: Oral steroids

In a randomized controlled trial of 267 people with herniated disc, researchers found that there was no significant difference in pain relief between the group receiving oral steroids (prednisone) and the group receiving a placebo. Both groups saw improvement, but even after a year, there was no difference between the two (except in rate of disability, which was slightly lower in the prednisone group).

Again, this is a case of the side effects outweighing the negligible benefits. In addition to headache, mood swings, and irregular heartbeat, long-term use of prednisone is a risk factor for osteoporosis, which may increase the risk of spinal injury leading to pain.

With these common medications increasingly debunked in the research, there are other treatment options to consider.


Staying physically active is an important treatment option for back pain. While it may seem counterintuitive to move when you are in pain, keeping your muscles strong and engaged can be the key to a healthy back. Focus on stretches and core work, but don’t forget low-impact cardiovascular exercise such as biking, swimming, and hiking.

Dietary changes

Although it may not work as quickly as some medications, eating a healthy diet full of anti-inflammatory foods can make a tremendous difference in back pain. Adding these foods while eliminating common inflammation-causing foods like sugar, wheat, and dairy can help manage pain.

Weight management

The more weight we carry on our bodies, the more stress there is on our joints. Maintaining a healthy weight with diet and exercise can be an important part of treatment for back pain, especially in cases where back pain is due to compression injuries such as herniated discs or inflammation caused by spinal stenosis.

Complementary medicine

Acupuncture is gaining traction as an effective treatment for low back pain. Chiropractic care can also be an excellent first-line treatment that minimizes the chance of spinal surgery in the future. Mindfulness meditation and biofeedback have both been shown to diminish the perception of pain. All of these treatments are nearly side-effect free, and many are now covered by insurance.

As more research uncovers medications that are not as effective as advertised, more people are turning to lifestyle changes and complementary medicine to manage chronic pain. Which treatments have you tried, and did they work for you?

Image by Michelle Tribe via Flickr


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