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Which pain reliever is best for back pain?

Tylenol or ibuprofen may be used to alleviate back pain. Here’s how to choose the best treatment option for you.
Rebecca Rovenstine writer headshot
By | Oct. 24, 2024 Medically reviewed by Samantha Marr, DNP, APN, AGPCNP-BC, CCRN
Women looking up at an iburpofen and Tylenol pill: Which pain medication is best for back pain?

Key takeaways

  • Tylenol and ibuprofen are both good over-the-counter medication options to treat back pain.

  • Ibuprofen may provide more pain relief since it also helps reduce inflammation, which may be an underlying cause of back pain.

  • Ibuprofen can cause adverse gastrointestinal events, so healthcare providers may prefer Tylenol for back pain treatment.

In this article:

Many people experience back pain as they get older. It is the leading cause of disability worldwide, with 619 million people saying they experienced low back pain over the course of a year, according to the World Health Organization. 

Although rehabilitation is the most beneficial, the most accessible treatment option is over-the-counter pain relievers. Two of the most popular choices for reducing back pain are Tylenol (acetaminophen) and ibuprofen, but which one is better for back pain? Below, we’ve talked to the experts to find out which is best for all types of back pain.

Is Tylenol or ibuprofen better for back pain? 

“Both acetaminophen and ibuprofen can help with back pain, but they work differently and have different side effects,” said Dr. Raj Dasgupta, Chief Medical Advisor for Fortune Recommends Health. 

Before deciding between Tylenol and ibuprofen to treat your back pain, it can be helpful to understand how both medications work. Acetaminophen, sold under the brand name Tylenol, is an analgesic that reduces pain and fevers. Ibuprofen, which can be sold under the brand names Advil or Motrin, is a nonsteroidal anti-inflammatory drug (NSAID) that helps reduce inflammation, pain, and fever. 

Certain cases of back pain may be caused by inflammation, so opting for ibuprofen over Tylenol would be beneficial in these scenarios. One example is arthritis, which is caused by inflammation in the joints. While other common causes of back pain, like degenerative disc disease, herniated discs, scoliosis, and strain, are not caused by inflammation, but ibuprofen can still help treat the pain.

Overall, research recommends ibuprofen over Tylenol for the most back pain relief. A review of over 135 studies found that nonsteroidal anti-inflammatory drugs, like ibuprofen, may be more effective at treating spine pain. However, researchers noted this should be for short-term use with lower doses.

The European Journal of Pain also determined that ibuprofen was typically the better choice for a variety of pain conditions in its 2015 systematic review. When comparing paracetamol (acetaminophen) and ibuprofen, its meta-analysis found that “at standard doses in different painful conditions, ibuprofen was usually superior.”

Safety and potential side effects

As with any medication, there are potential side effects to consider. Before taking any new medication, it’s always important to consult your healthcare provider. They can even help design a personalized pain management plan, considering your current medications, back pain symptoms, and other health concerns.

Rare side effects of Tylenol

Side effects from normal doses of Tylenol are rare. The following are signs of allergic reactions or liver damage. If you experience these symptoms, you should seek medical help.

  • Irritated skin: rash, hives, blistering skin
  • Difficulty breathing or swallowing
  • Nausea or vomiting
  • Yellowing of the skin
  • Loss of appetite
  • Fatigue
  • Dark stools or dark urine

Common side effects of Ibuprofen

  • Headaches
  • Dizziness
  • Nausea or vomiting
  • Indigestion
  • Heartburn
  • Upset Stomach
  • Stomach Pain
  • Constipation

The side effects aren’t the only thing to think about when choosing ibuprofen or Tylenol.

“There are other considerations when choosing your medications, including the side reactions in the body and the way the body processes each medication we take,” explained Dr. Michael Gerling, MD, board-certified orthopedic spine surgeon and founder of the Gerling Institute. 

Considerations for Ibuprofen

“Ibuprofen is processed through the kidneys and has other side effects in the body,” said Dr. Gerling. “It can be dangerous to use ibuprofen if you have a kidney disorder or take other medications that affect the kidneys.”

While ibuprofen isn’t a blood thinner, it does make it more difficult for blood to clot. Due to this, those with bleeding disorders need to use caution with ibuprofen. Ibuprofen can also affect blood pressure, putting users at higher risk of heart attack or stroke. 

Those with heart disease, kidney disease, or kidney damage should use extreme caution and speak to their healthcare provider before taking any painkillers, including ibuprofen.

Another downside to ibuprofen is that it can irritate the stomach. The risk for adverse gastrointestinal events, such as stomach ulcers or stomach bleeding, is higher when taking ibuprofen, especially with long-term use. 

Considerations for Tylenol

“Tylenol is filtered through the liver and therefore would put stress on the liver if taken in high doses,” said Dr. Gerling. “That being said, patients with liver disorders should not take Tylenol.”

Along with individuals with liver disease, those who frequently drink alcohol should also use caution when taking Tylenol and acetaminophen-based medications. Since alcohol is also processed in the liver, it can cause additional stress on the vital organ.

Dr. Gerling advised that many pain medications are blended with Tylenol, so before taking additional Tylenol on top of these medications, you should consult with a medical professional.

Overall, Tylenol is safer for more populations than ibuprofen and has fewer side effects, so healthcare providers more commonly recommend it for treating back pain. 

Tylenol vs. ibuprofen dosage for back pain

When using Tylenol for back pain, you should go off the standard dosage. The standard dose of Tylenol for adults and children 12 or older is 650 mg, which is usually two tablets or gel capsules every four to six hours as needed. The maximum daily dose is 3,250 mg of Tylenol in 24 hours.

You should also take the standard dosage when taking ibuprofen for back pain. The standard dose of ibuprofen for pain relief is 200 mg to 400 mg every four to six hours as needed. The maximum daily dose is 1200 mg for over-the-counter ibuprofen or 3200 mg if you’re taking prescription strength.

Can you combine back pain medications?

It is possible to take both Tylenol and ibuprofen at the same time.

“As ibuprofen and acetaminophen are processed differently in the body, they do not typically cross-react and cause problems when taken together,” said Dr. Gerling. “As they are both effective pain relievers, taking them together can be very helpful and is not typically problematic.”

A clinical trial in 2017 found that a combination of ibuprofen and acetaminophen provides faster and longer pain relief for patients with sudden lower back pain. It also had favorable effects on mobility.

If you prefer to take an NSAID but ibuprofen is rough on your stomach, there are other over-the-counter options to try, like naproxen, sold under the brand name Aleve. The popular over-the-counter pain reliever, Excedrin, uses acetaminophen and aspirin (an NSAID), so you don’t have to make as many tablets or capsules.

The bottom line

Tylenol and ibuprofen can both help provide pain relief when experiencing back pain. Generally, ibuprofen is better at treating back pain, but it’s not recommended for those with kidney problems or those who experience gastrointestinal issues. When experiencing extended back pain, your best option is to seek medical advice for an appropriate pain management plan.