Prescription NSAIDs: Non-steroidal Anti-Inflammatory Drugs for Neck or Back Pain

When over-the-counter medications don’t help relieve your neck or back pain, your doctor may recommend one of these non-opioid drugs as a treatment option.

An over-the-counter (OTC) non-steroidal anti-inflammatory drug (NSAID) is a common first-line treatment to help reduce neck and back pain. There are different NSAIDs, which belong to a large pain-relieving class of drugs called analgesics taken to alleviate inflammation and pain. However, sometimes an OTC NSAID isn’t enough, and that’s when you see your doctor, who may prescribe a stronger non-steroidal anti-inflammatory medication.
Pharmacist tray filled with pills.An NSAID may be prescribed instead of an opioid drug to help manage neck or back pain.Can I Skip the OTC NSAID and Get a Prescription Right Away?
Prescription NSAIDs are stronger than their OTC counterparts (Aleve and Advil are two common OTC NSAIDs). As such, your doctor needs to understand how you’ve responded to OTC versions before considering prescription NSAIDs.

When your doctor recommends trying an OTC version of a medication before writing you a prescription—that is called step therapy. Step therapy means your doctor will want you to try the most conservative and cost-effective options first before “stepping” you up to more potent, riskier and more expensive treatments.

You may be surprised to know that OTC NSAIDs are highly effective at managing many types of neck and back pain, even complex types associated with spinal arthritis (eg, spondylosis). But, if you haven’t experienced relief with OTC medications, talk to your doctor about the next step in your treatment plan. This may include a prescription NSAID.

Types of Prescription NSAIDs
Many types of prescription-strength NSAIDs are available, and your doctor will select the appropriate one based one your medical history and spinal condition. Below are examples of prescription NSAIDs prescribed to treat spinal pain (generic names are listed first, and a brand name example is in parentheses):

  • Celecoxib (Celebrex)
  • Diclofenac (Voltaren)
  • Fenoprofen (Nalfon)
  • Flurbiprofen (Ocufen)
  • Indomethacin (Indocin)
  • Ketorolac (Toradol)
  • Mefenamic acid (Ponstel)
  • Meloxicam (Mobic)
  • Oxaprozin (Daypro)
  • Piroxicam (Feldene)
  • Sulindac (Clinoril)

Unlike OTC NSAIDs, some prescription NSAIDs may be available in other forms besides a pill. For example, diclofenac has gel, patch, and solution formulations.

A Word on Celebrex
Celecoxib, which is better known under the brand name Celebrex, is among the most frequently prescribed NSAIDs for back pain. It belongs to a class of prescription NSAIDs called COX-2 inhibitors, which blocks the action of the cyclooxygenase molecule.

Celebrex is the only COX-2 inhibitor currently available in the United States. You can learn more about this drug in this Celecoxib Patient Guide published on PracticalPainManagement.com; one of SpineUniverse.com's sister-sites.

Side effects of COX-2 inhibitors include an increased risk of cardiovascular problems, such as heart attack or blood clots. And while COX-2 inhibitors pose a lower risk of stomach problems than traditional NSAIDs, there is still a risk. So, if you have a gastrointestinal condition, make sure to talk to your doctor about it before taking these medications.

Safely Using Prescription NSAIDs
Prescription-strength NSAIDs pack more power against pain and inflammation than their OTC counterparts, but they also carry more risks.

Each type of prescription NSAID has its own set of possible side effects, so make sure to ask your doctor to review them with you before you pick up your prescription. You may also discuss any questions about your medication with your pharmacist.

The most common side effect associated with NSAIDs is the risk of stomach and gastrointestinal problems. Some people have also experienced elevated blood pressure and kidney function problems while taking these medications.

Additionally, the US Food and Drug Administration (FDA) issued a warning that non-aspirin NSAIDs increase the chance of a heart attack or stroke. You can read more about this risk in the article, NSAIDs for Neck or Back Pain: Helpful or Harmful?.

If you’re concerned that you may be susceptible to these complications, talk to your doctor.

Prescription NSAIDs: A Strong Ally Against Back Pain
If over-the-counter medications are not helping to reduce your back or neck pain, talk to your doctor about whether a prescription NSAID might be the best next step for you. Because these drugs are strong and carry some risk, be sure to ask your doctor about side effects, how to take the medication, and red flags you need to know once you start the medication.

Updated on: 07/09/18
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10 Back and Neck Pain Medication Safety Tips

Much can be lost in translation from the time your physician writes your prescription to when your pharmacist fills it. These 10 tips will help you advocate for your health in the complex world of prescription drugs.
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