Acetaminophen or Tylenol for Back Pain

Taking pain medication.
Taking pain medication. Ray Kachatorian/Photolibrary/Getty Images

Searching for an over-the-counter medication for your back or neck pain? Tylenol, or acetaminophen, may be a possibility. Here are a few of the basics:

Acetaminophen, the Active Ingredient

The active ingredient in Tylenol is acetaminophen. Categorized as an analgesic, acetaminophen is an over-the-counter medication used to relieve pain and reduce fever. Acetaminophen is found in many other pain medications besides Tylenol, including Excedrin, Vanquish and Aspirin-Free Anacin.

Acetaminophen is also available in generic form, as well as in combination with other drugs.

Related: Active Ingredient

Acetaminophen is neither an opioid (i.e., narcotic pain reliever) nor an NSAID (anti-inflammatory.)  Because of this, it may allow you avoid side effects and/or complications that make other pain medicines impractical as choices.  That said, acetaminophen does come with the risk of liver toxicity.

What it Does

Tylenol is used for short-term pain relief for mild to moderate pain, and to temporarily reduce fever. You  might consider taking this medication for back or neck pain due to muscle ache and/or arthritis. 

Even though acetaminophen is widely used, it may not relieve low back pain as well as you think.  A 2015 review and meta-analysis published in the British Medical Journal found high quality evidence that taking it does not result in lumbar spine pain relief.

Tylenol for Back Pain - How It Does Its Work

Tylenol affects the central nervous system.

It works by reducing the amount of brain chemicals that excite pain signals. It also exerts a cooling effect by inhibiting the prostaglandins that play a role in the brain’s heat regulating center. 

Related: What to Do for Mild or Moderate Back Pain

Forms of Acetaminophen

Tylenol and acetaminophen come in tablet form.

 This includes extended release tablets, capsules, and  liquid, or drop form. You can take Tylenol with or without food. It also comes as a suppository.

Side Effects and Complications – Alcohol with Tylenol

The Tylenol label warns that taking acetaminophen can cause liver disease.  Because of this, the label says, if you take more than 3 drinks every day you should talk to your doctor about also taking acetaminophen.

The BMJ study mentioned above also found high quality evidence that people who take paracetamol (which is another name for acetaminophen) every day are almost 4 times as likely to have abnormal liver function test results than those who took a placebo pill.  Just the same, the authors say that the clinical relevance of the abnormal liver tests are unclear.

Side Effects – Allergies to Acetaminophen

Allergy to acetaminophen and/or other ingredients in the medication is possible. If you have a known allergy to any of the ingredients listed on the box, don’t take this medication. If you're unsure, talk to your doctor.  And if you do have an allergic reaction after taking acetaminophen, seek medical attention immediately.


Buck, M., Pharm D. FCCP, FPPAG. Intravenous Acetaminophen Use in Infants and Children. Medscape website.

Machado, G., PhD., et. al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ March 31. 2015.

Teater, D., M.D., Evidence for the efficacy of pain medications. National Safety Council.

Health Conditions and Other Medications
If you take blood thinners (anticoagulants), for example Coumadin (warfarin), seizure medication, especially Tegretol (carbamazepine), Dilantin(phenytoin), or phenobarbital, phenothiazines, INH(isoniazid), or other pain, fever, or cough or cold medication, be sure to ask your doctor if it is OK to also take Tylenol or other acetaminophen.

According to the Hepatitis C Project, the active ingredient in Tylenol, acetaminophen, can be found in approximately 200 other medications.

As mentioned above, the range for a safe dosage of Tylenol is very narrow. This means that if you take more than one medication, it is essential to read the labels for each one of them to be sure that you are getting acetaminophen only once. The risk of overdose effects is amplified if you drink or have chronic alcoholism, or other liver disease.

Storing Tylenol
Many people store medications, including Tylenol, in their bathroom medicine chest, or in the kitchen, near the faucet. But to keep this medication in good working order, it is best to store it away from heat and moisture. Keep the pills in the bottle it came in, and make sure the bottle is tightly closed.

It is very important to keep Tylenol and other acetaminophen products away from a child’s reach, as taking it inappropriately can do irreparable harm.

If your Tylenol is outdated or you no longer need it, throw it away. But first ask your pharmacist the proper way to do so.

Although it is widely used, Tylenol works in a very narrow margin of safety. If you take too much, your liver may become toxic very quickly. Unfortunately, the amount of Tylenol that causes liver toxicity is different from person to person, and some researchers think that problems can occur at the dosage amount listed on the label.

This is especially true if you drink or have chronic alcoholism. If you are at all unsure how much Tylenol or acetaminophen to take, or if you should take it at all, ask your doctor.

If your doctor has you taking Tylenol regularly and you miss a dose, take as soon as you remember. But if it is almost time for the next dose, just wait. In any case, don’t double dose.

Over Dosage
Taken in proper doses, acetaminophen, the active ingredient in Tylenol utilizes a chemical “pathway” in the liver to break down the medication and metabolize it. When you take more than you should, the chemical pathway gets overwhelmed, as if there were too much “traffic” in the pathway. When this happens, medication molecules are rerouted to a different chemical pathway. The alternate route breaks the drug down differently than does the primary route; one of the big differences between the chemical pathways is that the alternate route creates toxic by-products that kill liver cells.

What Did You Learn About Tylenol? Test Your Tylenol Knowledge.

Now that you have read up on taking Tylenol for back pain or neck pain, find out how much you've learned by taking the Tylenol for Back Pain Quiz. Quizzing yourself helps you to ingrain the facts and details about the medication, and may help you pick up some safety information you didn't get the first time.


Acetaminophen. Jan 2008.
Acetaminophen. Medline Plus. October 1 2007. Rumack, B. Acetaminophen misconceptions. Hepatology. July 2004
Van Mil, A., Janssens, A. Acetaminophen use by chronic alcohol abuser: a therapeutic dose may be too much for the liver. Ned Tijdschr Geneeskd. March 16 2002.
Kuffner, e. Dart, R. Bogdan, G., Hill, R. Casper, E. Darton, L. Effect of maximal daily doses of acetaminophen on the liver of alcoholic patients: a randomized, double-blind, placebo-controlled trial. Arch Intern Med Oct 8 2001
Seirafi, M., Iten, A., Hadengue, A. Acetaminophen: hepatotoxicity at therapeutic doses and risk factors. Rev Med Suisse. Oct 17 2007.
Kuffner, E. et al. The effect of acetaminophen (four grams a day for three consecutive days) on hepatic tests in alcoholic patients--a multicenter randomized study BMC Med. 2007 May 30;5:13.
Dart, R., Baily, E. Does therapeutic use of acetaminophen cause acute liver failure? Pharmacotherapy. 2007 Sep;27(9):1219-30.
Larson, A. Clin Liver Dis. 2007 Aug;11(3):525-48, vi. Related Articles, Acetaminophen hepatotoxicity.
Polson J, Lee WM. AASLD position paper: the management of acute liver failure.
Franciscus, A. Highleyman, L. Acetaminophen and Your Liver HCSP Fact Sheet. Hepitits C Support Project.

Continue Reading