Background: Low back pain is an important problem in public health and consumed high cost in management. In low back pain defined to 3 stages as acute, subacute and chronic.  There are many methods to manage in acute low back pain such as non steroidal anti-inflammatory drugs, paracetamol, muscle relaxant and nonphamacological therapy.  Superficial heat is one of methods that less evidence but has less complication, side effect and cost to management.Objective: To compare the therapeutic effect of superficial heat and non steroidal anti-inflamatory drugs in acute low back pain.Method: Prospective randomize controlled studies in 100 patients which divided into 2 groups.  First group has 50 patients got superficial heat. Second group got non steroidal anti-inflammatory drugs.  In both groups, patients can take paracetamol when they had suffered from pain and recorded the number of drug, used VAS, Oswestry test and number of paracetamol used were compare between two groups.Result: It was found that superficial heat and non steroidal anti-inflammatory drugs can relieve pain (VAS) and decreased Oswestry test (p-value < 0.0001 in both group). Non steroidal anti-inflammatory drugs got more relieve pain, decreased Oswestry test and less number of paracetamol than superficial heat (p-value = 0.011, 0.049, 0.027) Conclusion: Superficial heat and non steroid anti-inflammatory drugs can used to manage in acute low back pain but non steroidal anti-inflammatory drug is better than superficial heat in therapeutic effect.