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My patients often asked which is better for their back and neck pain, Tylenol or an NSAID. My answer to that question is usually an NSAID, but that is not always the case. Let’s delve into what these medicines are, how they work and their side effects to see when one is better for some patients.

Tylenol, or acetaminophen, is an anti-fever and anti-pain medication. The brand name Tylenol is owned by Johnson & Johnson, so it is the only manufacturer allowed to sell acetaminophen under that brand name. That said, other drug manufacturers can sell acetaminophen but cannot use the Tylenol name. The active ingredient in Tylenol is paracetamol and that is the name that is often used overseas while Tylenol and acetaminophen are used in the United States.

Tylenol was introduced in the U.S. by McNeil Pharmaceutical (which was later acquired by Johnson & Johnson) in 1995 to compete with aspirin in treating fevers in children. In fact, Tylenol is prefered for use in children for fevers since aspirin can increase the chance of a rare potentially fatal condition called Reyes syndrome. This condition is caused by a virus infection, but studies have shown that taking aspirin during the viral infection can increase the chance of the viral infection becoming fatal. It is mainly for this reason that aspirin is not recommended to treat fevers in young children.

Tylenol is metabolized in the liver and at high doses can affect liver function. Because of this, patients with impaired liver function, such as those with a history of hepatitis or a history of chronic alcohol abuse, should be careful in taking Tylenol, since it could further damage their liver. Unlike NSAIDs, Tylenol is less likely to cause GI/stomach ulcers or affect the kidneys.

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NSAID (non-steroidal anti-inflammatory drugs), is a large category of medications used to treat aches and pain as well as fevers. There are many medications in the category, some of the common ones are aspirin and ibuprofen (brand name Motrin). They work by preventing the body from making certain inflammatory substances called prostaglandins which are responsible for pain and swelling seen in some disorders. These medicines work best when taken on a regular basis so that the body can maintain a certain blood level. It is for this same reason — their need to take them on a regular basis — that they are likely to lead to both stomach ulcers and kidney damage.

Some of the newer NSAID are thought to be safer for the stomach and kidneys but the risk of ulcers and kidney damage still exists. To reduce the chance of GI/stomach ulcers it is recommended that NSAIDs are taken with food; this decreases the chance of ulcers but does not eliminate it. It is advisable that people should stop taking NSAIDs if they develop heart burn while on them. Also, if patients are going to take NSAIDs for a prolonged period of time they should get a renal panel blood test to see how well their kidneys are functioning.

Both acetaminophen and NSAIDs can be very effective for musculoskeletal pain including lower back pain and neck pain. In fact, they and not narcotics are the first line medications for these conditions. As mentioned above, NSAIDs need to be taken on a regular basis to be most effective. Because of this, for my patients who have a history of GI ulcers or who are susceptible or who have a history of kidney disease, NSAIDs are not the preferred medications. For these patients, acetaminophen is preferred as long as they have normal liver function.

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Dr. Dwight S. Tyndall, FAAOS, is a minimally invasive spine surgeon practicing in the Region at DrSpine.com. His column, which appears every other week, covers a wide range of health and medical issues.

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