There is no single "best" medication for spinal arthritis—the right one depends on your pain level, other health conditions, and how your body responds
Spinal arthritis (also called cervical or lumbar spondylosis, depending on where it occurs) causes pain and stiffness as cartilage wears down in the neck or lower back. Doctors typically start with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, move to prescription NSAIDs if needed, and may add muscle relaxants, topical creams, or injections if those do not work. Some people find relief with one medication; others need a combination. What works for your neighbor may not work for you, and what works today may need adjustment in six months.
The goal is not to find a perfect medication that works forever, but to find what reduces your pain enough that you can move, sleep, and do the things that matter to you. That often means trying one medication for four to six weeks, tracking how it affects your pain and your daily life, and then deciding with your doctor whether to continue, adjust the dose, or try something different.
Key Takeaways
- Over-the-counter NSAIDs like ibuprofen are usually the first step, but they carry risks for people with heart disease, kidney problems, or stomach ulcers.
- Prescription NSAIDs are stronger but have the same risks as over-the-counter versions and should not be used long-term without monitoring.
- Muscle relaxants like cyclobenzaprine can ease spasm-related pain but cause drowsiness and are not safe for everyone.
- Steroid injections into the spine can reduce inflammation for weeks or months but are not a permanent fix and have limits on how often you can receive them.
- Your doctor needs to know about all your other medications and health conditions before prescribing anything for spinal arthritis.
Over-the-Counter NSAIDs: Where most people start
Ibuprofen (Advil, Motrin) and naproxen (Aleve) are the most common first choice because they reduce both pain and inflammation, and they are inexpensive. Ibuprofen works faster but wears off in four to six hours, so you take it more often. Naproxen lasts longer—eight to twelve hours—but takes longer to kick in. Acetaminophen (Tylenol) does not reduce inflammation, so it is less effective for arthritis pain, though some people use it alongside an NSAID.
The catch: NSAIDs can damage your stomach lining, raise blood pressure, and stress your kidneys, especially if you take them daily for months. If you have a history of ulcers, heart disease, high blood pressure, or kidney disease, tell your doctor before using NSAIDs regularly. People over 65 are at higher risk for these side effects. Taking an NSAID with food helps protect your stomach, but it does not eliminate the risk. If you are taking a blood thinner like warfarin or aspirin, NSAIDs can increase bleeding risk, so your doctor needs to know that too.
Prescription NSAIDs: Stronger but with the same cautions
If over-the-counter NSAIDs do not control your pain, your doctor may prescribe a stronger NSAID like meloxicam (Anjeso), celecoxib (Celebrex), or indomethacin. These are not fundamentally different from ibuprofen—they are straightforward higher doses or formulated to stay in your system longer. Meloxicam, for example, is taken once daily and lasts 24 hours, which can make it easier to remember than taking ibuprofen four times a day.
Prescription NSAIDs carry the same stomach, kidney, and heart risks as over-the-counter versions, and they are not meant for long-term daily use without monitoring. Your doctor will likely order blood work to check your kidney function and may ask you to take a stomach-protective medication like omeprazole (Prilosec) alongside the NSAID. Some people find that a prescription NSAID works better than over-the-counter options because the longer-lasting formulation keeps pain more stable throughout the day, but you will need regular check-ins with your doctor to make sure it is safe for you.
Muscle relaxants for spasm-related stiffness
Spinal arthritis often causes muscle spasms around the affected area, and muscle relaxants like cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and tizanidine (Zanaflex) can ease that tightness. They work by calming nerve signals to the muscles rather than by reducing inflammation. Many people find them helpful for a few weeks after a flare-up or after physical therapy, especially when spasm is preventing them from moving or sleeping.
The downside is significant: muscle relaxants cause drowsiness, dizziness, and sometimes confusion, especially in older adults. They can interact with alcohol, pain medications, and sleep aids. They are not meant for long-term daily use—most doctors prescribe them for two to three weeks at a time. If you drive or operate machinery, muscle relaxants are not safe. Talk to your doctor about whether the benefit is worth the side effects in your situation, and whether taking one at night only (rather than during the day) might work for you.
Steroid injections: Short-term relief when medication is not enough
If NSAIDs and muscle relaxants do not control your pain, your doctor may recommend a steroid injection directly into the space around the spinal cord (epidural injection) or into the facet joints of the spine. These injections deliver a strong anti-inflammatory medication right where the pain is, and they often work when pills do not. Relief can last anywhere from a few weeks to several months, and some people find that the pain reduction lets them do physical therapy more effectively.
Injections are not a permanent fix—the arthritis is still there, and pain usually returns. Most doctors limit you to three or four injections per year because repeated steroid exposure carries risks, including bone weakening and infection. The procedure itself is minimally invasive and done in an outpatient clinic, but it does carry small risks of nerve damage or infection. Your doctor will discuss these risks and whether injections make sense for you before scheduling, and will explain what to expect during recovery.
Topical creams and patches
Creams and patches containing NSAIDs (like diclofenac) or capsaicin (a compound from hot peppers) can provide localized relief without the systemic side effects of pills. You explore them directly to the skin over the painful area. Topical NSAIDs work best for pain in the lower back or neck that is close to the surface; they do not penetrate deeply enough to help pain from arthritis in the center of the spine.
Capsaicin cream works differently—it depletes a pain-signaling chemical in nerve endings and can take several applications before you feel relief. Some people find it very helpful; others find the burning sensation intolerable. Topical options are often used alongside oral medications rather than instead of them. They are generally safe for older adults and people who cannot take NSAIDs by mouth, though you should wash your hands after explore them and avoid touching your eyes.
What to ask your doctor before starting any medication
Before your doctor prescribes anything, make sure you discuss: all other medications you take (including over-the-counter drugs and supplements), any history of stomach ulcers, heart disease, high blood pressure, kidney disease, or liver disease, whether you are on a blood thinner, and whether you are pregnant or breastfeeding. Tell your doctor if you have tried any arthritis medications before and whether they worked or caused side effects.
Ask how long you should take the medication before deciding whether it is working, what side effects to watch for, and when to call if something feels wrong. Ask whether the medication is meant to be temporary (like a muscle relaxant for a few weeks) or ongoing. Ask what to do if the medication stops working—whether the dose can be increased, whether you should try something else, or whether other options like injections or physical therapy make sense. Write down the answers so you remember them later.
When to seek care or change your approach
Contact your doctor if you develop stomach pain, black or bloody stools, shortness of breath, or swelling in your legs while taking NSAIDs—these can signal serious side effects. If a medication causes dizziness, confusion, or severe drowsiness, stop taking it and call your doctor the same day. If your pain is not improving after four to six weeks on a medication, or if it is getting worse, tell your doctor rather than waiting.
Spinal arthritis often improves with physical therapy, heat, weight management, and posture changes alongside medication. If you are taking medication but not doing physical therapy or other non-medication treatments, ask your doctor whether adding those might let you use less medication or lower doses. Some people find that combining approaches works better than medication alone, and that they can reduce or stop medication once they have built strength and flexibility back up.
Frequently Asked Questions
Can I take ibuprofen and naproxen together?
No. Both are NSAIDs and taking them together increases the risk of stomach damage and kidney problems without improving pain relief. If one NSAID is not working, switch to a different one or talk to your doctor about other options, but do not combine them.
Will I need to take medication forever?
Not necessarily. Some people take medication during flare-ups and stop when pain settles. Others find that physical therapy, weight loss, or posture changes reduce their need for medication over time. Your doctor can help you figure out whether you need ongoing medication or whether you can take breaks.
Is it safe to take an NSAID every day for months?
Daily NSAID use for months increases risks of stomach, kidney, and heart problems, especially if you are over 65 or have other health conditions. If you need daily pain relief, talk to your doctor about whether a prescription NSAID with stomach protection, a different medication class, or injections might be safer for you.
What if I cannot take NSAIDs because of my other health conditions?
Muscle relaxants, topical creams, steroid injections, and certain other medications like gabapentin or pregabalin can help when NSAIDs are not an option. Physical therapy, heat, and weight management also play a role. Your doctor can work with you to find a plan that fits your specific situation.
Do I need to try medication before considering injections?
Most doctors recommend starting with medication and physical therapy first, but if your pain is severe or medication is not working after a few weeks, injections may be considered sooner. There is no strict rule—your doctor will base the decision on how much pain you are in and how much it is affecting your daily life.