Which is better for sciatica pain tylenol or ibuprofen

Emergency Care Discharge Instructions

Instruction summary

Sciatica is a pain that comes from the spine. The spine is made up of a column of small bones (called “vertebrae”) that have spongey cushions stacked between them, called “discs.” These discs are cushions that act as shock absorbers for our spine. Sometimes these discs are injured and protrude outwards. When discs protrude outwards, they can push on nerves and cause pain. This pain moves along the pathway of the nerve, and can be excruciating. If sciatica is happening in your lower back, it is typical for the pain to shoot down the back of your leg, along the path of the nerve.

For most people, sciatica gets better within 4-6 weeks.

If you were prescribed pain medication, take it as directed. If you are under the age of 70 and have no kidney problems, this usually means starting with ibuprofen (which is the same thing as Advil or Motrin) or acetaminophen (same thing as Tylenol, which is safe in all age groups). You may have been given a stronger pain medication, such as Tylenol #3 or Percocet. These stronger medications can make you drowsy, so do not drive or operate heavy machinery when taking either of them. Tylenol #3 and Percocet usually also cause constipation, so take an over-the-counter medicine for constipation, such as Metamucil or Docusate, at the same time as taking these medications.

Complete bedrest is no longer recommended. However, do take it easy for a few days, and avoid all heavy lifting (which includes lifting children). Don’t sit for prolonged periods, because this actually increases the strain on your back. When you are lying in bed, a firm mattress is best. See if putting pillows underneath your knees helps.

If the pain persists for longer than a few weeks, talk to your family doctor about physiotherapy.

Spine surgery becomes an option if the pain continues for months. Given the high risks associated with operating on the spine, most spine surgeons do not want to see patients until they have experienced six months or more of daily pain.

Reasons to return to the ER

1. Difficulties with urination (no urine for >6 hours despite attempts to pee)
2. Incontinence of stool (pooping without meaning to)
3. Weakness in both of your legs
4. Numbness in the top part of your inner thigh on both sides
5. Fever (≥38.0 °C or 100.4 °F)

In the journals

Some drugs are safer and more effective for managing spine pain in people ages 65 and older, according to research published online June 27, 2022, by Drugs and Aging.

Investigators reviewed 138 trials that examined how various drugs help with spine related pain caused by muscular, arthritic, or nerve pain in the neck, midback, and low back. The results are a helpful guide for physicians and older adults. Here are the key findings:

Over-the-counter drugs: Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin IB) are safe and effective, although NSAIDs are more helpful. NSAIDs should be taken in the lowest effective doses to avoid side effects.

Nerve pain medication: Gabapentin (Neurontin) and pregabalin (Lyrica) may help reduce neck and back nerve pain, especially sciatica. Begin with low doses to avoid daytime drowsiness and fall risk.

Muscle relaxants. Tizanidine (Zanaflex) and baclofen (Lioresal) may reduce pain from muscle spasms. People with liver disease should avoid tizanidine, and those with kidney disease should take baclofen in lower doses. Also, avoid the drugs carisoprodol (Soma), chlorzoxazone (generic only), cyclobenzaprine (Amrix), metaxalone (Metaxall), methocarbamol (Robaxin), and orphena-drine (generic only) because of their risk for drowsiness and falls.

Antidepressants. Duloxetine (Cymbalta), a selective serotonin-norepinephrine reuptake inhibitor, appears safe for spine-related nerve pain like sciatica. Avoid most tricyclic antidepressants because of potential side effects. Nortriptyline (Pamelor) and desipramine (Norpramin) are better tolerated at lower doses.

Corticosteroids. A short course may help, but the evidence is not strong.

Traditional opioids. Avoid due to addiction risk.

Image: pedro arquero/Getty Images

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