First let’s talk about what is meant by “types” of over-the-counter pain medication. These are distinguished by the “active ingredient,” which is the chemical substance that makes the changes, for example, relieve pain, reduce inflammation, etc., that are stated on the drug package labels. (Active ingredients can cause side effects, too, so this may also play a role in your decision to take one medication over another.)

As you’ll see, active ingredients can be grouped together into drug classes. As far as over-the-counter pain drugs go, the two main classes are NSAIDs (non-steroidal anti-inflammatories) and analgesics (pain relievers). Sometimes a drug will serve both purposes; other times it will not.

All but one of the drugs described here are over-the-counter NSAIDs, which can reduce pain, fever and inflammation. COX-2 inhibitors, another kind of NSAID, may also be helpful in treating your symptoms, but these drugs are available by prescription only.

And finally, the drugs discussed below are available as a prescription in higher doses.

As an NSAID, aspirin not only reduces back or neck pain, it plays a role in controlling inflammation, which may be helpful following an injury or trauma.

The active ingredient in aspirin does its work by holding back the production of prostaglandins, which are short-lived chemicals in the body, responsible for inflammation, as well as pain.

Although rare, aspirin can have serious side effects, not the least of which are stomach problems. But unlike other NSAIDs, aspirin, when used correctly, may improve cardiovascular health. Speak to your healthcare provider about this if you would like to know more.

Because of that, many experts believe that of all the NSAIDs, aspirin is the best choice. The People’s Pharmacy, which is both an informative website and a talk radio show aired on National Public Radio puts forth this statement:

“If we were banished to a desert island and could only take one pain reliever, we’d choose aspirin.”

The reasons, they say, is that along with relieving pain and reducing inflammation, aspirin helps reduce the risk of cardiovascular events such as heart attack or stroke. And, the People’s Pharmacy says, evidence suggests that aspirin may confer anti-cancer benefits, as well.

Brand names include Motrin, Advil and Nuprin.

Like aspirin, ibuprofen is an NSAID, which means it not only reduces back or neck pain but plays a role in containing the process of (inflammation) itself. Anti-inflammatory drugs with ibuprofen as their active ingredient inhibit the production of prostaglandins, and therefore inflammation and pain.

Side effects may include stomach problems and cardiovascular events. 

One of the most important warnings in this new update is that the risk of stroke or heart attack is present much earlier in the treatment course than experts originally believed. 

“There is no period of use shown to be without risk,” says Judy Racoosin, M.D., M.P.H., deputy director of FDA’s Division of Anesthesia, Analgesia, and Addiction Products.

To protect yourself from unintended overdose (and therefore increased risk of serious or even fatal side effects) the FDA advises looking at the active ingredients in the Drug Facts label of each medication you take, and be sure that only one of them contains an NSAID. In other words, don’t take more than one NSAID at a time.

Another warning is that those who already have cardiovascular disease, or who have had cardiac bypass surgery are at the highest risk for a cardiovascular event associated with taking ibuprofen or other NSAID.

If you’ve had a heart attack, your risk for another one (and possibly even dying from it) is higher, too.

But everyone, regardless of their state of cardiovascular health, is put at a higher risk for taking ibuprofen, the FDA informs us.

As with the other anti-inflammatory drugs, naproxen works largely by inhibiting the formation of prostaglandins.

Brand names include Aleve and Naprosyn.

Note that while all NSAIDs (with the possible exception of aspirin) raise your risk of heart attack or stroke, at least one study indicates that naproxen raises it the least.

This may be because naproxen is a long acting drug, where ibuprofen is short acting. A long acting drug does not need to be taken as frequently, thereby exposing you to less risk for the drug’s side effects.

The GI related side effects of taking NSAIDs (i.e., stomach ulcers and/or bleeding) increases the longer you take this type of drug. So it’s best to take only the lowest dose necessary for delivering pain relief.

Tylenol helps muscle-related back pain and/or arthritis. It may work by reducing the amount of the brain chemical that excites pain signals, thereby, affecting the central nervous system. It also exerts a cooling effect by inhibiting the prostaglandins that play a role in the brain’s heat-regulating center.

But if you have liver problems, or if you consume a lot of alcohol, you should tread carefully when it comes to Tylenol. It is very easy to take too much of this drug, which may then result in serious or fatal liver toxicity.

This pain and frequency relationship is especially strong, they say, between first bouts and subsequent ones. Specifically, the longer the first episode lasts, the more the low back pain is likely to come back later. And each time it does, it will be more severe, and likely cause more disability. 

In this way, your first round of back pain may make subsequent ones worse, and may also contribute to a long term chronic back condition to boot.

The authors point out that spine pain is one of the top five disabling conditions in the U.S.

Given all this, you may want to be sure that taking medication for your back or neck pain at all is, indeed, your best course of action.

Another 2017 study, this one published in the Annals of Rheumatic Diseases, compared taking NSAIDs for spine pain with doing nothing.

While the NSAIDs did help with the pain, it wasn’t that much. In fact, the authors conclude that there really are no simple type analgesics that work well enough (as compared with placebo).

And when you factor in the risk for GI tract bleeding and/or ulcers, and/or the elevated risk for heart attack or stroke, you may want to rethink your pain relief strategy—especially if your pain is fairly mild.

One very popular strategy you might try is exercise.

A 2014 study published in the Ochsner Journal found strengthening the low back and/or neck extensor muscles (which are located in back and help you arch rather than flex or round your spine) helps reduce pain and may help you move quickly past many types of spine problems. If you see a healthcare provider about neck or back pain, consider taking a proactive approach by asking for a prescription to physical therapy.