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

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

Table 1

Examples of SystemicOTC Products Marketedfor Back Pain

Brand Name (active ingredients)

Backaid Maximum Strength BackRelief (acetaminophen 500 mg,pamabrom 25 mg)

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

Doan's Extra Strength Pain Reliever,Caplets (magnesium salicylate tetrahydrate580 mg)

Doan's Extra Strength PM NighttimeBack Pain Relief (magnesium salicylatetetrahydrate 580 mg, diphenhydramineHCl 25 mg)

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

Hyland's BackAche with ArnicaTablets (benzoicum acidum 3XHPUS, colchicum autumnale 3XHPUS, sulphur 3X HPUS, arnicamontana 6X HPUS, rhus toxicodendron6X HPUS)

Momentum Maximum StrengthBackache Relief Coated Tablets(magnesium salicylate tetrahydrate580 mg)

Everyone has or will experience somedegree of back pain in his or her lifetime.Back pain is a very prevalent complaintfor many individuals, and lower back painaffects an estimated 50% of individualsaged 60 years and older but can occurat any age.¹ Statistics from the AmericanAcademy of Orthopedic Surgeons estimatesthat over the course of an averagelifetime, 80% of individuals in theUnited States will suffer from at least oneepisode of back pain.² In addition, an estimated15% to 20% of Americans reportback pain yearly, and 50% of individualswho suffer with an episode of lower backpain will have a recurring episode within1 year.^2,3 The severity of lower back paincan range from a dull constant pain toan abrupt sharp pain that may impedemovement or the ability to stand straight.Acute lower back pain can last for a fewdays or weeks, but many individuals alsosuffer from chronic back pain.

The majority of acute back pain casesare the result of muscle strains or sprains,and the pain may be apparent immediatelyafter an injury or worsen graduallyover a few hours.⁴ Examples of factors/causes that may increase an individual'srisk of developing back pain includeincreasing age, sedentary lifestyle,excess weight, poor posture, impropertechnique when lifting heavy objects,poor sleeping posture, as well as stressand muscle tension, accident or sportsrelatedinjury, or physically strenuouswork.^4,5 Back pain also may be caused bycertain medical conditions (eg, osteoarthritis,endometriosis, kidney stones,and fibromyalgia).^1,4,5 Many women alsomay experience acute lower back painbefore or during their menstrual cycleand during pregnancy.^4-6

Self-treatment of lower back pain islimited to episodes of acute lower backpain.⁴ Those individuals experiencingchronic back pain (ie, back pain lastinglonger than 6 weeks) should be referredto their primary health care provider forfurther medical care and treatment.⁴

Table 2

Examples of TopicalPreparations for Back Pain

Absorbine Jr Pain Relieving BackPatches

ActivOn Ultra Strength MedicatedPatch for Back & Body

BENGAY Air Activated PainRelieving Pads for Back

BENGAY Heat Therapy Patch

Beyond Bodi Heat Pain RelievingHeat Pad for Back

Blue Stop Pain Relieving Cream

Capzasin Pain Relief, Back & BodyPatch

Cura-Heat Air-Activated Neck/Shoulder & Back Heat TherapyPatches

Dr. Scholl's Back Pain ReliefOrthotics

Icy Hot Extra Strength MedicatedPatch, Back & Large Areas

ThermaCare Back & Hip Heat Wraps

Thermipaq Therapeutic Hot & ColdPad

Thermophore Automatic Moist HeatPacks

WellPatch Pain Relieving Pads,Backache

In general, the goals of treating acutelower back pain are to prevent furtherinjury and reduce pain and discomfort,thus increasing the affected individual'squality of life. A variety of OTC productsare available for the managementand treatment of back pain, includingsystemic analgesics (nonsteroidal antiinflammatorydrugs and acetaminophen;Table 1) and topical analgesics (Table 2),as well as some alternative products.These products are available as singleentityor combination products and areavailable in various dosage forms. Thefactors that may influence proper selectiondepend on patient preference, dosageform, ease of use, and cost of theproduct. Prior to recommending anyof these products, pharmacists shouldascertain if self-treatment is appropriateand refer patients to seek further medicalevaluation when warranted. Pharmacistsalso should assess the patient for possibleallergies/hypersensitivities, drug interactions,and contraindications. Patientsalso should be counseled on proper use,as well as the possible adverse effectsassociated with the use of these products.Individuals with preexisting medicalconditions and those women who arepregnant or lactating should always seekadvice from their primary health care providerprior to using any of these products.Patients should be reminded to immediatelycontact their primary health careprovider if back pain does not show anysigns of improvement after 72 hours ofself-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 productsfor the self-treatment of acute back pain,pharmacists also can suggest variousnonpharmacologic measures that mayalleviate back pain, such as hot or coldtherapy, massage therapy, and preventivemeasures that may decrease theoccurrence of lower back pain, such asalways using proper lifting techniques,which eliminates stress on the back, andpracticing proper posture when sitting orstanding. Patients also may be encouragedto discuss possible physical therapyand exercises to prevent or decrease theincidence of back pain with their primaryhealth care providers.

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

• The National Institutes of HealthNational Institute of Arthritis andMusculoskeletal and Skin Diseasesat www.niams.nih.gov.
• American Pain Foundation Web siteat www.painfoundation.org.

References

• 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.
• 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.
• Low Back Pain. Neurosurgery Today. American Association of Neurological Surgeons Web site. www.neurosurgerytoday.org/what/patient_e/low.asp. Accessed July 5, 2008.
• 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.
• 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.
• 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.