If you sometimes need more relief, over-the-counter anti-inflammatories such as ibuprofen (Advil and generic) can be the first choice, according to ACP guidelines. But they often aren’t appropriate for older adults, who may be at a higher risk of side effects such as gastrointestinal bleeding, says Jesse Charnoff, MD, a physiatrist at the Hospital for Special Surgery in New York City.
Acetaminophen (Tylenol and generic) may be a safer bet if you stay under 3,000 mg daily, he says. Diclofenac topical (Voltaren Arthritis Pain and generic), an OTC anti-inflammatory cream, can also provide relief. (But this and other anti-inflammatories might not be appropriate for people who are taking blood thinners.)
Another option may be an OTC patch that has lidocaine, a numbing agent. For all of the above, ask your doctor how often and for how long you can use them.
If you see no improvement after treatments like physical therapy or medications like those mentioned above, the ACP recommends the prescription antidepressant duloxetine (Cymbalta and generic), so check with your doctor.
Prescription muscle relaxants such as cyclobenzaprine (Flexeril and generic) can lead to drowsiness and increase fall risk, so discuss your situation with your doctor. Avoid prescription opioids, which can lead to dependency. They’re no more effective than a placebo for short-term low back pain, according to a 2023 study in The Lancet, and can lead to side effects like constipation and dizziness, which can be more pronounced in older adults, Charnoff says.
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