I've been researching this topic for a while and found many contradictory results all over the place. I've left the more general "back pain" because I kind of get the same inconclusive results regardless of the issue coming from a muscle, a ligament or a herniated disk (and many studies treat acute back pain as a condition in itself, regardless of origin)

Are NSAIDs a good treatment for back pain, do they affect recovery?

One of many studies suggesting that NSAIDs interfere with the immune system role

Not clear, but small benefit from NSAIDs

Maybe using paracetamol is a better alternative

But maybe it's not much better than placebo

Just like NSAIDS

Even not taking into consideration other factors, even opioids could be detrimental to recovery

In all these studies and many more that pop up with a quick search I've read lots of contradictory conclusions and found lots of studies with low quality data trying to come up with conclusions (and many others concluding that nothing is clear)...

So is there even anything definitive in all of this?

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    I think "back injury" is far too non-specific and vague to attempt a general answer; unfortunately even in more specific cases the best way to proceed is often unclear. Individual people and their individual injuries make it a difficult topic to study.
    – Bryan Krause
    Commented Oct 26, 2021 at 3:13
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    I guess you are right, but I I left back injury intentionally non specific precisely because I didn't find any clear result for any of the usual causes. And while it's probably difficult to measure (specially pain reduction) I really believe there are some somewhat objective measurements that could be taken, like % of regression in cases of disk herniation, or strength recovery on muscle injury.
    – Mrbuho
    Commented Oct 26, 2021 at 11:20
  • I can see your point but where I see your question being broad (differently to @BryanKrause) is that you asked about a broad range of medication. If you narrow to just NSAIDs or just opioids as an example, the question will be more focused and maybe more answerable. Commented Oct 27, 2021 at 6:04
  • I have helped by narrowing to NSAIDs as the bulk of your question centres on them, but feel free to roll the edit back or re-edit to suit your needs. Commented Oct 27, 2021 at 6:28
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    I think your edit makes my question more easy to understand and answer while keeping the main idea, so thanks for that. Also, maybe it goes in the wrong direction (by adding more fluff) But I also added reference to an article about opioids.
    – Mrbuho
    Commented Oct 27, 2021 at 16:20

2 Answers 2


This is a difficult question to answer because it is very broad. Your sources concern a number of different pathologies which have different mechanisms and different treatment approaches.

It's important to differentiate between acute and chronic pain because chronic pain is not associated with continued damage to the tissues. This means that e.g. whether NSAIDs inhibit the immune system from contributing to healing may not be relevant to chronic pain where the initial insult has disappeared.

Back pain can be an acute musculoskeletal injury or chronic pain which is no longer associated with damage. It may also be musculoskeletal vs neuropathic which may have different management.

Your sources move between several levels of evidence from in vitro experiments to Cochrane reviews. In terms of evaluating the quality of evidence for current treatments it is probably better to stick to systematic reviews so I will use Cochrane from here. I will also restrict my answer to NSAIDs and paracetamol in reference to non-neuropathic back pain.

The short answer is that the evidence for any treatment isn't great, and the results are contradictory even when taking large numbers of studies in aggregate.

Non-steroidal anti-inflammatory drugs for low-back pain

The review authors conclude that NSAIDs are slightly effective for short-term symptomatic relief in patients with acute and chronic low-back pain without sciatica (pain and tingling radiating down the leg). In patients with acute sciatica, no difference in effect between NSAIDs and placebo was found.

The review authors also found that NSAIDs are not more effective than other drugs (paracetamol/acetaminophen, narcotic analgesics, and muscle relaxants). Placebo and paracetamol/acetaminophen had fewer side effects than NSAIDs, though the latter has fewer side effects than muscle relaxants and narcotic analgesics.

Only 42% of the studies were considered to be of high quality. Many of the studies had small numbers of patients, which limits the ability to detect differences between the NSAID and the control group. There are few data on long term results and long-term side effects.

So, NSAIDs might help a bit in the short term.

Paracetamol for low back pain

We found high-quality evidence that paracetamol (4 g per day) is no better than placebo for relieving acute LBP in either the short or longer term. It also worked no better than placebo on the other aspects studied, such as quality of life and sleep quality. About one in five people reported side effects, though few were serious, and there was no difference between intervention and control groups. As most of the participants studied were middle-aged, we cannot be sure that the findings would be the same for other age groups.

So paracetamol (i.e. acetaminophen) is probably not ideal. This is confusing in relation to NSAIDs being found to be no better than paracetamol but still effective.

In practice

The current UK NICE guidelines for management of low back pain are basically:

  1. Rule out any "red flag" pathology
  2. Identify any underlying cause. If back pain is secondary to a treatable cause e.g. osteoporosis then that should be dealt with first.
  3. Provide information on exercises for low back pain
  4. The current guidelines then suggest to offer NSAIDs, and if these are not tolerated to offer codeine. These are both given for the shortest possible time at the lowest dose that relieves symptoms.

This is probably based on that on balance NSAIDs are probably the least worst choice although it would be fair to conclude we are still not very good at treating this condition.


Their are so many options you can select.. But first try to find out exact cause and treat them accordingly. Treatment as per condition is important . use hot water fomentation .. rest .. analgesics , anti inflammatory ie NSAIDS....also precautions ..nd lumbar belt .. precautions like don't bend forward ..don't lift the weight on head nd use thick pillow of you have cervical ..and do flexibility andROM.and stretching exercises

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