Paracetamol or Ibuprofen for Back Pain?

Paracetamol or Ibuprofen for Back Pain?

I sometimes get asked by patients with back pain which is the best over-the-counter pain-reliever to take, paracetamol or ibuprofen? Although there are some pros and cons for each, which I will cover in this article, the scientific evidence clearly shows that non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are your best bet. 

Whilst paracetamol has been shown to help with headaches, and knee & hip arthritis, a large 20212 study showed that paracetamol was not effective at relieving low back pain.  

In contrast, a large 2008 study showed that NSAIDs are effective for short‐term symptomatic relief in patients with both acute and chronic low‐back pain without sciatica. These and other studies led to an official recommendation in the UK to recommend NSAIDs like ibuprofen and not paracetamol for managing low back pain. 

There is however a dark side to taking NSAIDs that people should be aware of. 

NSAIDs work by blocking the production of prostaglandins, which are hormone-like substances. Prostaglandins are also involved in  forming a protective layer in the stomach, which means NSAID use can make this lining more vulnerable to damage by stomach acid. This can lead to stomach inflammation,ulcers, and even bleeding. The problem is far from trivial, as it has been estimated that in the United States alone, NSAIDs are responsible for over 100,000 hospitalizations and 16,500 deaths annually due to complications such as gastrointestinal bleeding, renal dysfunction, and cardiovascular events.

There is also another less well known problem with taking NSAIDs, the fact that they can interfere with the healing process. It’s important to remember Inflammation is actually the body’s natural response to an injury and is essential for the successful repair of damaged tissue. Whilst NSAIDS might be useful for reducing pain, they are doing this at the cost of interfering with the body’s natural healing/inflammation process. 

This is not just a theoretical concern, as there is evidence that NSAIDs can impair the healing of bones, cartilage, tendons and soft tissues like skin and muscle.

Several studies have looked at the effects of NSAIDs on bone healing, and have found that these drugs may delay or impair the healing of bone fractures. A 2019 meta-analysis looking at the issue concluded that taking NSAIDs increased the chances of bones not healing properly. 

In cartilage healing, NSAIDs have been shown to inhibit chondrocyte proliferation and extracellular matrix synthesis, which may contribute to cartilage degeneration. A 2019 review  recommended that their use should be avoided after cartilage repair procedures.

In tendons, NSAIDs have been shown to decrease their mechanical strength and level of collagen synthesis, and are detrimental to healing overall.

There is also evidence that NSAIDs can impair the healing of soft tissues, such as skin and muscle. With skin, there is evidence to suggest that NSAIDs may delay wound healing, impair reepithelialization, and reduce collagen deposition, which are all important processes in the skin's healing response. In muscle healing, NSAIDs have been shown to inhibit satellite cell proliferation, which may lead to impaired muscle regeneration.

So there you have it - if you want to take something for your back pain then NSAIDs like ibuprofen are a better bet than paracetamol. However, try to minimise the amount you take and how long you take it for, so you limit the impact on the healing process and minimise the risk of side-effects. 

If you are looking for an East Grinstead Osteopath please get in touch with:

Cliff Russell, Registered Osteopath

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