	At the Kraus Back and Neck Institute (KBNI), we specialize in non-surgical as well as surgical treatments of Back and Neck Pain.

Pain Management

Nonsteroidal Anti-Inflammatory Drug (NSAID)

For Lower Back Pain Management

NSAIDs are used primarily to treat inflammation, mild to moderate pain and fever such as headaches, Arthritis, sports injuries and menstrual cramps. NSAIDs are included in many cold and allergy medications. Prescription aspirin is used to treat the symptoms of Rheumatoid Arthritis and Osteoarthritis.

NSAIDs are available in a regular, delayed-release or a chewable tablet, powder and gum to be ingested orally (by mouth) every four to six hours. Prescription NSAIDs are often administered as an extended-release tablet (tablet that releases medication slowly over a period of time.) once or twice a day.

Patients with a history of ulcers, kidney problems, or heart disease should consult their doctor before taking NSAIDs.

REMINDER: You should always talk to your doctor before beginning a new medication regimen. These suggestions do not to substitute for medical advice. Please consult your physician.

Types of NSAIDs

Aspirin

Brand Names: Aspergum, Bayer, Bufferin, Ecotrin, Empirin

Relieves: Mild to moderate pain and inflammation

Available Over-the-Counter: Yes

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, rash, ringing in the ears
Less common: insomnia
Serious: vomiting, agitation, fatigue, confusion, swelling of face; Reye's syndrome (allergic reaction causing swelling of face, lips and eyelids)

Note: Do not give to children under 16 years of age, unless instructed by your doctor. Notify your doctor before any surgery if you take NSAIDs as it may cause increased bleeding.

Aspirin/ Caffeine

Brand Names: Anacin (capsules and tablets)

Relieves: Mild to moderate pain and inflammation; reduces fever

Available Over-the-Counter: Yes

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, rash, ringing in the ears
Less common: insomnia
Serious: vomiting, agitation, fatigue, confusion, swelling of face; Reye's syndrome (allergic reaction causing swelling of face, lips and eyelids)

Note: Do not give to children under 16 years of age, unless instructed by your doctor; notify your doctor before any surgery if you take NSAIDs as it may cause increased bleeding.

Celecoxib

Brand Names: Celebrex

Relieves: Pain, inflammation, stiffness of osteoarthritis and rheumatoid arthritis

Available Over-the-Counter: No

Mechanism of action: Celecoxib inhibits the enzyme cyclooxygenase 2 (COX-2), reducing synthesis of prostaglandins, chemicals in the body which cause pain and inflammation.

Side Effects

Common: indigestion, diarrhea, abdominal pain
Less Common: swelling, flatulence, sore throat
Serious: gastric ulcers, tarry stools, liver disease

Note: Do not take with other NSAIDS. Notify your doctor if you are taking Furosemide, ACE Inhibitors, Fluconazole, Lithium or Warfarin.

Diclofenac Systemic

Brand Names: Cataflam, Voltaren

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, gout, and soft tissue injury

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side effects

Commom: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision

Note: Inhibits blood coagulation and may increase bleeding at surgery. Stop taking well before surgery. NSAIDs can increase your risk of life-threatening heart or circulatory problems, including heart attack and stroke.

Diclofenac/ Misoprostol

Brand Names: Arthrotec

Relieves: Symptoms of Osteoarthritis or Rheumatoid Arthritis [Link to respective pages]

Available Over-the-Counter: No

Mechanism of action: Diclofenac is an NSAID that interferes with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity. Misoprostol is a synthetic prostaglandin which prevents ulcers and enhances the stomach's natural healing.

Side effects

Common: stomach pain, diarrhea, nausea, flatulence
Less common: fatigue, weakness, fever, dizziness, loss of appetite, dry mouth, menstrual irregularities, depression
Serious: cardiac irregularities, fainting, coma, seizures

Note: NSAIDs inhibit blood coagulation and may increase bleeding at surgery. Stop taking well before surgery. NSAIDs can increase your risk of life threatening heart or circulatory problems, including heart attack and stroke.

Diflunisal

Brand Names: Dolobid

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis and soft tissue injuries

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision

Etodolac

Brand Names: Lodine

Relieves: Mild to moderate pain and inflammation from tendinitis, arthritis, bursitis, gout, soft tissue injuries, migraines, vascular headaches, menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side effects

Common: nausea, vomiting, diarrhea, constipation, headache
Less common: sores in mouth, depression, rashes, ringing in ears, blurred vision
Serious: shortness of breath, swelling of legs, ulcers, tarry stools

Note: NSAIDs inhibit blood coagulation and may increase bleeding at surgery. Stop meds well before surgery. NSAIDs can increase your risk of life threatening heart or circulatory problems, including heart attack and stroke.

Fenoprofen Calcium

Brand Names: Nalfon

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Flurbiprofen Oral

Brand Names: Ansaid, Froben

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Hydrocodone Bitartrate / Ibuprofen

Brand Name(s): Vicoprofen

Relieves: Short-term relief of acute pain

Available Over-the-Counter: No

Mechanism of action: Hydrocodone blocks pain at the spinal cord and brain. Ibuprofen is an NSAID which interferes with the formation of prostaglandins, chemicals which cause inflammation and pain.

Side Effects

Common: headache, dizziness, lightheadedness, nausea, upset stomach, drowsiness, constipation
Less common: abdominal pain, weakenss, insomnia, nervousness, diarrhea, flatulence, dry mouth.

Ibuprofen

Brand Names: Advil, Excedrin IB, Genpril, Ibuprin, Midol IB, Motrin, Nuprin, Pamprin IB

Relieves: Mild to moderate pain,arthritis, migraine headache

Available Over-the-Counter: Yes

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: indigestion, nausea, vomiting
Less common: sleeping difficulty, nervousness, irritability
Serious: difficulty swallowing, lightheadedness, fainting, difficulty breathing, shortness of breath, acute decrease in urine output

Note: Ibuprofen is intended for short-term use. Do not take more ibuprofen than recommended. An overdose can damage your stomach or intestines.

Indomethacin

Brand Names: Indocid, Indocin SR

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps. Because of it's greater toxicity, should only be used when other NSAIDs are ineffective

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Ketoprofen

Brand Names: Orudis, Oruvail

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, menstrual cramps

Available Over-the-Counter: Yes

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects:

Common: Constipation, diarrhea, dizziness, drowsiness, gas, headache, heartburn, nausea, stomach upset.
Serious: Changes in vision, fever, blisters, rash, hives, swelling, difficulty breathing or swallowing, unusual bleeding or bruising, loss of appetite, nausea, pain in the upper right part of the stomach, flu-like symptoms, yellowing of the skin or eyes, pale skin, fast heartbeat, cloudy, discolored, or bloody urine, back pain, difficult or painful urination

Ketorolac Tromethamine Systemic

Brand Names: Toradol

Relieves: Moderate to severe pain and inflammation, usually post surgery

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: gastric distress
Less common: drowsiness, diarrhea, cunfusion, ringing in ears, sensitivity to sunlight, headache

Note: Do not take with aspirin or other non-steroidal anti-inflammatory medications.

Meclofenamate Sodium

Brand Names: Meclomen

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps

Available over the counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Mefenamic Acid

Brand Name(s): Ponstan

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Meloxicam

Brand Name(s): Mobic

Relieves: pain, stiffness and inflammation associated with osteoarthritis

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: diarrhea
Less common: sore throat, nausea, dizziness, upper respiratory tract infection
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Note:Do not take if allergic to aspirin or other NSAIDS. Do not use in cases of advanced liver or kidney disease.

Nabumetone

Brand Name(s): Relafen

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Naproxen

Brand Name(s): Aleve, Anaprox, Naprosyn

Relieves: Minor pain or inflammation associated with headaches, common cold, toothache, muscle aches, backache, arthritis, gout, tendinitis, bursitis, and menstrual cramps

Available Over-the-Counter: Yes

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Oxaprozin

Brand Names: Daypro

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Piroxicam

Brand Name(s): Feldene

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Rofecoxib

Brand Names: Vioxx

Relieves: Chronic osteoarthritis pain

Available Over-the-Counter: No

Mechanism of action: Rofecoxib inhibits the enzyme cyclooxygenase 2 (COX-2), reducing synthesis of prostaglandins, chemicals in the body which cause pain and inflammation.

Side Effects

Common: indigestion, swelling, increased blood pressure
Less common: flatulence, sore throat, abdominal pain
Serious: gastric ulcers, tarry stools, liver disease

Note: Do not take with other NSAIDs. Notify your doctor if you are taking Furosemide, ACE Inhibitors, Fluconazole, Lithium, or Warfarin.

Salsalate

Brand Names: Amigesic, Disalcid, Salflex

Relieves: Pain from Rheumatoid Arthritis and Osteoarthritis

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: abdominal cramps, indigestion, nausea, vomiting,
Less common: none
Serious: blood in urine, severe diarrhea, difficulty swallowing, lightheadedness, confusion, seizures, tarry stools

Note: Use caution if you have anemia, ulcers, hyperthyroidism, glucose-6-phosphate dehydrogenase deficiency, hypertension, gout, heart disease, bleeding disorders, or asthma. Prolonged use may cause gastrointestinal problems, ulcers, kidney and liver dysfunction.

Sulindac

Brand Name(s): Clinoril

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure

Tolmetin Sodium

Brand Name(s): Tolectin

Relieves: Mild to moderate pain and inflammation caused by tendinitis, arthritis, bursitis, bout, soft tissue injury, migraines, vascular headaches, and menstrual cramps

Available Over-the-Counter: No

Mechanism of action: NSAIDs interfere with the release of prostaglandins, chemicals in the body which cause inflammation and nerve sensitivity.

Side Effects

Common: nausea, vomiting, heartburn, diarrhea, constipation, headache
Less common: ulcers or sores in mouth, rashes or blistering of skin, ringing sound in ears, tingling of hands or feet, seizures, blurred vision
Serious: shortness of breath, wheezing, chest pain, peptic ulcer disease, kidney failure