Is Naproxen or Ibuprofen Better for Back Pain?

Both naproxen (Aleve) and ibuprofen (Advil; Motrin) are equally effective for back pain. They both belong to a class of popular medicines called Nonsteroidal Anti-inflammatory Drugs (NSAIDs), which relieve pain and reduce inflammation.

Over 80% of adults will get back pain during their lifetime. You may be out gardening or lifting weights and you lift a heavy object with poor posture, and your back muscles begin to spasm. It happens. In many cases, the back pain will heal with non-medicated therapies such as rest, ice, and heat. To learn more about non-drug therapies, click on the article: How To Relieve Sudden Back Pain.

However, sometimes ice and heat are not enough. In this article, we shall be discussing how to use NSAIDs like ibuprofen or naproxen for back pain. These medications are a temporary fix to help reduce inflammation and pain and take some of the edge off so that you can move and walk around and carry on with your day without debilitating back pain. We shall also go over when it not to take these medications, especially if you have certain medical conditions (contraindications) that make it unsafe for you to take them. So, let’s begin.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs are popular medicines that relieve pain and reduce inflammation. They include popular OTC medications such as Ibuprofen (brand name is Advil or Motrin) or Naproxen (brand name is Aleve). One research study analyzed 11 clinical trials and found that NSAIDs modestly improved back pain after one week. Ibuprofen and naproxen are better than acetaminophen (Tylenol) for back pain because NSAIDs have an anti-inflammatory component, which means they can reduce inflammation and pain in your back after an injury. Acetaminophen (Tylenol) helps with pain but it does not have an antiinflammatory component.

What NSAID dose should I take?

You should take ibuprofen or naproxen on a regular basis for the first 3 to 5 days after an injury, rather than taking the medication as needed for pain. The reason you want to take an NSAID around the clock for the first few days is that the inflammation in your back is at its greatest right after an injury and NSAID will help reduce that inflammation. You can take EITHER ibuprofen or naproxen, NOT both. The recommended dose is the same as the prescription strength so please check with your doctor first if these doses are right for you:

• Ibuprofen (400 to 600 mg four times daily)
• Naproxen (220 to 440 mg twice daily)

If you do not like taking tablets, then you can try diclofenac 1% gel (Voltaren gel), which is a gel that you can apply to your back. This gel is an NSAID that is available over-the-counter and is usually used for arthritis of the hands and knees. My back surgeon told me that diclofenac 1% gel works for some of his patients with back pain, but there is no medical evidence to back it up.

When are NSAIDs unsafe to take?

You should not take NSAIDs if you have certain medical conditions that make NSAIDs unsafe to take. These medical conditions are called contraindications. If you have any of the medical conditions below, please first ask your doctor if it is safe for you to take an NSAID:

• Digestive ulcers or bleeding: If you are over 65 years old or have ulcers or bleeding in your stomach, esophagus, or intestines, then NSAIDs could put you at greater risk for bleeding and ulcers. Do not take NSAIDs without first consulting your doctor. Your doctor may recommend antacids such as omeprazole (Prilosec) or lansoprazole (Prevacid) to reduce the risk of developing a digestive ulcer or bleeding when you are taking an NSAID.
• Heart disease or stroke: If you are at high risk for a heart attack, heart failure, or stroke, then an NSAID such as ibuprofen or naproxen may not be right for you. NSAIDs such as ibuprofen or naproxen can increase your risk of getting a heart attack, stroke, or heart failure if you already have heart disease or have had a stroke in the past. Please first consult your doctor.
• High Blood Pressure: If you have high blood pressure, please ask your doctor if an NSAID is right for you since NSAIDs can increase blood pressure. If you need to take an NSAID for back pain, please take the lowest NSAID dose for the shortest time as possible.
• Before Surgery: Your doctor may recommend that you stop taking an NSAID for up to a week before surgery since NSAIDs can place you at greater risk for bleeding during a surgery.
• Blood thinners: NSAIDs such as ibuprofen and naproxen already put you at risk of bleeding. The risk for bleeding becomes greater if you are already taking blood thinners such as warfarin (Coumadin), aspirin, clopidogrel (Plavix), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) or edoxaban (Savaysa). Please check with your doctor if it is okay to take an NSAID if you are already taking a blood thinner.
• Kidney Disease: If you have kidney disease, do not take NSAIDs since NSAIDs can make your kidneys worse if you already have kidney disease.
• Liver Disease: If you have severe liver disease such as cirrhosis, do not take NSAIDs since NSAIDs can make your liver worse if you already have severe liver disease.
• Pregnant: We do NOT recommend NSAIDs for pregnant patients because NSAIDs can cause harm to the newborn, especially during the last 3 months of the pregnancy (3rd Trimester).

What side effects do NSAIDs have?

Most patients do not get major side effects when they take NSAIDs such as ibuprofen or naproxen for short term up to two weeks. However, you are at increased risk of side effects if you take NSAIDs for a long time or if you have medical problems such as a history of heart attack or stroke, kidney disease, or previous bleeding in your stomach or intestines that we discussed above (see the section above: When are NSAIDs unsafe to take?). The most common side effects of NSAIDs are as follows:

• Heartburn: NSAIDs can cause heartburn and stomach upset. You should take an NSAID with food to minimize heartburn.
• Stomach ulcers or bleeding: If you are over 65 years old or take NSAIDs for a long time (over a month) you may start to develop ulcers or bleeding in your stomach, esophagus, or intestines. Your doctor may recommend antacids such as omeprazole (Prilosec) or lansoprazole (Prevacid) to reduce the risk of developing a stomach ulcer or bleeding when you are taking an NSAID.
• Increased Blood Pressure: Your blood pressure may increase while taking an NSAID, but if you are taking blood pressure medications and your blood pressure is stable, NSAIDs probably will not affect your blood pressure that much.
• Kidney Disease: Avoid NSAIDs if you have kidney disease because NSAIDs can make your condition worse.
• Liver Disease: Although rare, taking NSAIDs for a long time may damage the liver. If you have to take NSAIDs for more than a month, your doctor may need to check your liver function with a blood test.

Verdict: Ibuprofen vs Naproxen for Back pain

So which is better for back pain: naproxen or ibuprofen? The answer is that they are equally effective and you can take either for back pain based on your preference. Not only do NSAIDs relieve pain, but they reduce any inflammation from an acute back injury. Make sure to take your NSAID with food to minimize stomach upset. You also need to take your NSAID regularly rather than as needed for the first 3-5 days after a back injury to reduce to inflammation in your back.

We do not recommend NSAIDs longer than 2 weeks without the advice of your doctor since NSAIDs can cause side effects such as stomach ulcers if taken for several months. Your doctor may recommend an antacid such as lansoprazole (Prevacid) if you need to take an NSAID for longer. We also do not recommend NSAIDs if you have had a history of heart attack or stroke, kidney disease, or previous bleeding in your stomach or intestines.

After your back begins to feel better, you will want to try some exercises to prevent future back pain. Click on our article: 6 Best Exercises for Chronic Low Back Pain.