Quick answer: most low back pain gets better within a few weeks with three things you can do without a prescription: keep moving, put heat on it, and take an over-the-counter anti-inflammatory such as ibuprofen (Advil, Motrin) or naproxen (Aleve) if your health allows it. Before you take anything, read the red flags below — some back pain is an emergency and no pill fixes it.
First things first: when back pain is an emergency
Most back pain is muscular and short-lived. A small share of it is a warning sign, and with those the clock matters. Go to the ER or call 911 today if you have any of these:
- Loss of bladder or bowel control, or you suddenly cannot urinate even though your bladder feels full.
- Numbness in the groin, inner thighs, or buttocks — the area that would touch a saddle.
- Weakness in one or both legs: your knee buckles, you trip, or your foot drags.
Together or on their own, these can mean the nerves at the base of the spine are being compressed. That is a surgical emergency and it does not wait until morning.
Get in-person care soon — not by video — if you have:
- Fever along with back pain, which can point to a spinal infection.
- Pain that started after a hard fall, a fall from height, or a car accident.
- A history of cancer with new back pain, unexplained weight loss, or pain that wakes you at night.
- Pain running down the leg with numbness or tingling that is getting worse by the day.
Call 911 if back pain comes with chest pain, trouble breathing, fainting, or if it is a tearing pain that hit all at once. Ongoing back pain in a young child also needs an in-person exam rather than telehealth.
The thing that helps most is free: keep moving
The first instinct for many people is to lie down and wait it out, and that is the opposite of what the guidelines say: long bed rest makes back pain worse, weakens the muscles that hold you up, and stretches out your recovery. A day or two of taking it easy can be necessary when the pain is sharp. After that, move as much as the pain lets you and get back to your routine as soon as you can. Skip heavy lifting, sudden twisting, and long stretches sitting in one position.
Heat and ice
Superficial heat has the better evidence for recent low back pain: a heating pad, a heat wrap, or a warm shower, over light clothing and for short stretches at a time. Ice is mostly used in the first hours after a fall; the evidence behind it is thinner, but if it feels better to you, use it wrapped in a towel, never straight on your skin.
What you can buy without a prescription
All of this is on the shelf at CVS, Walgreens, Walmart, or any U.S. pharmacy. In every case: read the Drug Facts label and follow the directions exactly.
Oral NSAIDs
Ibuprofen (Advil, Motrin) and naproxen (Aleve) are what the guidelines reach for first when a pill is warranted. Naproxen lasts longer, so you take it fewer times a day. Pick one of the two and stick with it — doubling up on NSAIDs raises the risk without adding relief — and use it for the shortest time that does the job.
Check with a professional before using them if you have an ulcer or stomach bleeding, kidney, liver, or heart disease, high blood pressure, if you take blood thinners or steroids, or if you are over 60. If you are pregnant, avoid them, especially at 20 weeks or later: the FDA warns they can harm the baby's kidneys.
Acetaminophen (Tylenol)
For back pain, acetaminophen helps less than most people expect. In studies of recent low back pain it worked no better than a sugar pill. It is still the safer choice for anyone who cannot take NSAIDs. If you use it, make sure nothing else you are taking also contains acetaminophen — plenty of cold and flu remedies include it, and stacking them without realizing it damages the liver. Skip alcohol while you are taking it.
Creams, gels, and patches
Products with menthol and methyl salicylate (Salonpas, Icy Hot, Bengay) and over-the-counter lidocaine patches are labeled for backache and are a solid option if you would rather not take pills.
One label detail almost nobody reads: diclofenac gel (Voltaren Arthritis Pain) is sold over the counter, but its label clears it only for arthritis in the hands, wrists, elbows, feet, ankles, and knees. It specifically says it is not for the back, hip, or shoulder, because it was never studied on those areas.
And one rule that applies to all of them: never put heat or a tight bandage over a medicated cream or patch. That combination can burn your skin.
How to read the Drug Facts label
- Active ingredients: the actual medicine. Compare it across products so you do not take the same drug twice by accident.
- Uses: what the product is cleared for. If your body part is not listed there, that product is not for you.
- Warnings: the conditions and the other medicines it should not be combined with.
- Directions: how much and how often, by age. Follow it exactly.
Warning about kids: aspirin is not given to children or teenagers, because it is linked to Reye's syndrome, a serious illness affecting the liver and brain. Check labels — some products, like Pepto-Bismol, contain salicylates.
See our guide to over-the-counter medicines in the U.S.
When telehealth is the wrong tool for your back
A video visit is good for guidance, but nobody can put hands on your spine through a screen. You need in-person care if you have any of the red flags above, if the pain came from an accident, if an X-ray or MRI is needed, if you need physical therapy, or if the pain has been getting worse for weeks despite treatment. Emergencies go to 911 or the ER, always.
Where Doctor Matt fits in
In a video visit, a Colombian doctor who speaks Spanish goes through your symptoms, rules the red flags in or out with you, helps you understand which over-the-counter medicines sold in the U.S. fit your situation, and tells you honestly when you need to be seen in person.
The limits, stated in full: our doctors are licensed in Colombia and not in any U.S. state. That means we do not issue prescriptions valid at U.S. pharmacies and we have no physical clinic in the United States. We handle minor concerns only, by video, every day from 7:00 a.m. to 9:00 p.m. Colombia time, with no app and no membership, with or without insurance. We see children from about age one or two, not newborns.