/publications/issue/2008/2008-09/2008-09-8665

A Pharmacist's Guide to OTC Therapy: Acute Lower Back Pain

Author: Yvette C. Terrie, BSPharm, RPh


Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.



Table 1
Examples of Systemic OTC Products Marketed for Back Pain

Brand Name (active ingredients)

Backaid Maximum Strength Back Relief (acetaminophen 500 mg, pamabrom 25 mg)

Bayer Extra Strength Back & Body Coated Caplets (aspirin 500 mg, caffeine 32.5 mg)

Doan's Extra Strength Pain Reliever, Caplets (magnesium salicylate tetrahydrate 580 mg)

Doan's Extra Strength PM Nighttime Back Pain Relief (magnesium salicylate tetrahydrate 580 mg, diphenhydramine HCl 25 mg)

Excedrin Back & Body Caplets, Pain Reliever (acetaminophen 250 mg, buffered aspirin 250 mg)

Hyland's BackAche with Arnica Tablets (benzoicum acidum 3X HPUS, colchicum autumnale 3X HPUS, sulphur 3X HPUS, arnica montana 6X HPUS, rhus toxicodendron 6X HPUS)

Momentum Maximum Strength Backache Relief Coated Tablets (magnesium salicylate tetrahydrate 580 mg)

Everyone has or will experience some degree of back pain in his or her lifetime. Back pain is a very prevalent complaint for many individuals, and lower back pain affects an estimated 50% of individuals aged 60 years and older but can occur at any age.1 Statistics from the American Academy of Orthopedic Surgeons estimates that over the course of an average lifetime, 80% of individuals in the United States will suffer from at least one episode of back pain.2 In addition, an estimated 15% to 20% of Americans report back pain yearly, and 50% of individuals who suffer with an episode of lower back pain will have a recurring episode within 1 year.2,3 The severity of lower back pain can range from a dull constant pain to an abrupt sharp pain that may impede movement or the ability to stand straight. Acute lower back pain can last for a few days or weeks, but many individuals also suffer from chronic back pain.

The majority of acute back pain cases are the result of muscle strains or sprains, and the pain may be apparent immediately after an injury or worsen gradually over a few hours.4 Examples of factors/ causes that may increase an individual's risk of developing back pain include increasing age, sedentary lifestyle, excess weight, poor posture, improper technique when lifting heavy objects, poor sleeping posture, as well as stress and muscle tension, accident or sportsrelated injury, or physically strenuous work.4,5 Back pain also may be caused by certain medical conditions (eg, osteoarthritis, endometriosis, kidney stones, and fibromyalgia).1,4,5 Many women also may experience acute lower back pain before or during their menstrual cycle and during pregnancy.4-6

Self-treatment of lower back pain is limited to episodes of acute lower back pain.4 Those individuals experiencing chronic back pain (ie, back pain lasting longer than 6 weeks) should be referred to their primary health care provider for further medical care and treatment.4

Table 2
Examples of Topical Preparations for Back Pain

Absorbine Jr Pain Relieving Back Patches

ActivOn Ultra Strength Medicated Patch for Back & Body

BENGAY Air Activated Pain Relieving Pads for Back

BENGAY Heat Therapy Patch

Beyond Bodi Heat Pain Relieving Heat Pad for Back

Blue Stop Pain Relieving Cream

Capzasin Pain Relief, Back & Body Patch

Cura-Heat Air-Activated Neck/ Shoulder & Back Heat Therapy Patches

Dr. Scholl's Back Pain Relief Orthotics

Icy Hot Extra Strength Medicated Patch, Back & Large Areas

ThermaCare Back & Hip Heat Wraps

Thermipaq Therapeutic Hot & Cold Pad

Thermophore Automatic Moist Heat Packs

WellPatch Pain Relieving Pads, Backache

In general, the goals of treating acute lower back pain are to prevent further injury and reduce pain and discomfort, thus increasing the affected individual's quality of life. A variety of OTC products are available for the management and treatment of back pain, including systemic analgesics (nonsteroidal antiinflammatory drugs and acetaminophen; Table 1) and topical analgesics (Table 2), as well as some alternative products. These products are available as singleentity or combination products and are available in various dosage forms. The factors that may influence proper selection depend on patient preference, dosage form, ease of use, and cost of the product. Prior to recommending any of these products, pharmacists should ascertain if self-treatment is appropriate and refer patients to seek further medical evaluation when warranted. Pharmacists also should assess the patient for possible allergies/hypersensitivities, drug interactions, and contraindications. Patients also should be counseled on proper use, as well as the possible adverse effects associated with the use of these products. Individuals with preexisting medical conditions and those women who are pregnant or lactating should always seek advice from their primary health care provider prior to using any of these products. Patients should be reminded to immediately contact their primary health care provider if back pain does not show any signs of improvement after 72 hours of self-care, if the pain continues to worsen, or if they experience any signs of numbness, tingling, or difficulty in moving.4,6

In addition to the use of OTC products for the self-treatment of acute back pain, pharmacists also can suggest various nonpharmacologic measures that may alleviate back pain, such as hot or cold therapy, massage therapy, and preventive measures that may decrease the occurrence of lower back pain, such as always using proper lifting techniques, which eliminates stress on the back, and practicing proper posture when sitting or standing. Patients also may be encouraged to discuss possible physical therapy and exercises to prevent or decrease the incidence of back pain with their primary health care providers.

For more information on back pain, please visit the following Web sites:

References

  1. Neck and Back Pain. In: Beers MH, Porter RS, Jones TV, Kaplan JL, Berkwits M, eds. The Merck Manual. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:323-326.
  2. Back Pain Fact Sheet. American Academy of Orthopedic Surgeons Web site. www.aaos.org/Research/stats/Back%20Pain%20Fact%20Sheet.pdf. Accessed July 5, 2008.
  3. Low Back Pain. Neurosurgery Today. American Association of Neurological Surgeons Web site. www.neurosurgerytoday.org/what/patient_e/low.asp. Accessed July 5, 2008.
  4. Wright E. Musculoskeletal Injuries and Disorders. In: Berardi RR, Kroon LA, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006:111-129.
  5. What is Back Pain. The National Institutes of Health's National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. www.niams.nih.gov/Health_Info/Back_Pain/default.asp. Accessed July 5, 2008.
  6. Back Pain Information Page. National Institute of Neurological Disorders and Stroke Web site. www.ninds.nih.gov/disorders/backpain/backpain.htm. Accessed July 5, 2008.