Patients often ask me whether they should take Muscle Relaxers, NSAID’s (ibuprofen) or Acetaminophen (Tylenol) for their back pain. Lets break down each option and I’ll let you be the judge.
Medication Statistics:

80% of patients are prescribed pain medications when experiencing back pain.
70% are NSAID’s (ibuprofen and aspirin)
33% are Muscle Relaxants
4% are Acetaminophen (Tylenol)
Acetaminophen use is associated with and increase risk of Asthma, Hypertension, elevated liver enzymes, and hearing loss.
Chronic NSAID use is associated with ulcer formation and hearing loss.
No difference was found between NSAID use verse Placebo for chronic low back pain with sciatica. However, short term use of NSAID was effective for chronic low back pain without sciatica symptoms.
Acetaminophen is NOT an anti-inflammatory like an NSAID.

*Its important to know that pain reduction dosing differs to that of an anti-inflammatory role. For example Ibuprofen (Advil, Motrin, Nuprin) taken 6-8hrs at 200-400mg is for pain reduction. The same taken four times a day at 600mg is for anti-inflammation. A typical rule of thumb on this topic is: Anti-Inflammatory effects are usually higher doses but more spread out during the day verses pain control.
Good alternatives to the traditional approach of Muscle Relaxers, NSAID’s, and Acetaminophen:

Tumeric
Ginger
Bioflavinoids (ie. Green Tea)
Boswellia
Omega-3s (DHA & EPA)

Take home message: If you have back pain, neck pain, headaches, or other types of pain you need to decide if the side effects of medication are worth the benefits. In my research there is little evidence proving the effectiveness of these medications. I always recommend patients to search out alternative options before going to the medicine cabinet.

Resources:

– 2011: Acetaminophen and Asthma Pediatrics Abstract  Pediatrics Summary of Acetaminophen and Asthma

– 2010: Acetaminophen and Hypertension Circulation Abstract  Circulation 2010 Abstract for HTN and Acetaminophen for patients with Coronary Artery Disease

– 2010: Pharmacotherapy Abstract  Elevated Liver Enzymes and Acetaminophen Use

– 2010: Journal of Medicine Abstract for Hearing Loss Association to Analgesic Use  Hearing Loss with Analgesic Use