We all know how frustrating and uncomfortable low back pain can be. Now, recent research suggests that mixing popular over-the-counter pain relievers such as acetaminophen (e.g., Tylenol) and NSAIDs (e.g., Ibuprofen) may be the best solution for low back pain.

Researchers in Germany found that taking only acetaminophen—otherwise known as paracetamol or Tylenol—was ineffective in improving the symptoms. Whereas it showed larger improvements after being combined with a nonsteroidal anti-inflammatory drug such as ibuprofen. Other examples of NSAIDs include naproxen, diclofenac, and celecoxib.

Low back pain is a condition causing the most disability worldwide. It is termed “acute” when symptoms persist for 2–12 weeks. It’s believed that about 60 percent of patients will develop chronic low back pain.

In this study, lead author Dr. Alice Baroncini and her colleagues worked to discover the most effective drug(s) for managing low back pain.

To do that, researchers accessed all the randomized controlled trials (RCTs) with data on the efficacy of muscle relaxants, NSAIDs, and paracetamol administration for acute low back pain. The team only looked at studies with data on participants over the age of 18 who suffered from neuropathic pain and acute pain in their lower back with symptoms lasting less than 12 weeks.

They defined acute low back pain as “idiopathic pain between the last ribs and the buttocks and persisting for less than 12 weeks.”

Overall, the researchers looked at data from 18 studies involving a total of 3,478 patients with acute low back pain. Of which 54 percent comprised women. The average follow-up for participants was roughly eight days.

Results showed that muscle relaxants and NSAIDs were effective in relieving pain and disability in acute low back pain in about a week. Although they found that combining both NSAIDs and paracetamol proved even more effective in improving symptoms than taking NSAIDs alone. 

To date, there has been limited knowledge concerning the best management for low back pain, and prior studies on the topic lack substantial data to arrive at definitive conclusions. 

While there are non-pharmacological treatments for acute low back pain like local heat, acupuncture, or massage, the team recommends that where these are not beneficial, therapeutic options can be offered.

They reiterate that the use of these pain medications should only serve as an alternative or second-line strategy once other non-pharmacological or non-invasive therapies have proven ineffective.

“This is a first step towards the optimization of the management of acute low back pain,” says Dr. Alice Baroncini. “However, specific patient characteristics such as having allergies and comorbidities must always be taken into consideration.”


People seeking treatment for acute low back pain can opt for NSAIDs, a combination of NSAIDs and paracetamol, or muscle relaxants to achieve better outcomes.

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