Back Pain

Back Pain

Low Back Pain Treatment

Self-Care at Home

General recommendations are to resume normal, or near normal, activity as soon as possible. However, stretching or activities that place additional strain on the back are discouraged.

    Sleeping with a pillow between the knees while lying on one side may increase comfort. Some doctors recommend lying on your back with a pillow under your knees.


    No specific back exercises were found that improved pain or increased functional ability in people with acute back pain. Exercise, however, may be useful for people with chronic back pain to help them return to normal activities and work. These exercises usually involve stretching maneuvers.


    Nonprescription medications may provide relief from pain.


        Ibuprofen (Advil, Nuprin, or Motrin), available over the counter, is an excellent medication for the short-term treatment of low back pain. Because of the risk of ulcers and gastrointestinal bleeding, talk with your doctor about using this medication for a long time.


        Acetaminophen (Tylenol) has been shown to be as effective as ibuprofen in relieving pain.


        Topical agents such as deep-heating rubs have not been shown to be effective.


        Some people seem to benefit from the use of ice or heat. Their use, although not proven effective, is not considered to be harmful. Take care: Do not use a heating pad on "high" or place ice directly on the skin.


    Most experts agree that prolonged bed rest is associated with a longer recovery period. Further, people on bed rest are more likely to develop depression, blood clots in the leg, and decreased muscle tone. Very few experts recommend more than a 48-hour period of decreased activity or bed rest. In other words, get up and get moving to the extent you can.



Medical Treatment

Initial treatment of low back pain is based on the assumption that the pain in about 90% of people will go away on its own in about a month. Many different treatment options are available. Some of them have been proven to work while others are of more questionable use. You should discuss all remedies you tried with your health-care provider.

Home care is recommended for the initial treatment of low back pain. Bed rest remains of unproven value, and most experts recommend no more than two days of bed rest or decreased activity. Some people with sciatica may benefit from two to fours days of rest. Application of local ice and heat provide relief for some people and should be tried. Acetaminophen and ibuprofen are useful for controlling pain.

    Many studies have called into question the usefulness of our present treatment of back pain. For any given person, it is not known if a particular therapy will provide benefit until it is tried. Your doctor may try treatments known to be helpful in the past.


Low Back Pain Medications

Medication treatment options depend on the precise diagnosis of the low back pain. Your doctor will decide which medication, if any, is best for you based on your medical history, allergies, and other medications you may be taking.

    Nonsteroidal anti-inflammatory medications (NSAIDs) are the mainstay of medical treatment for the relief of back pain. Ibuprofen, naproxen, ketoprofen, and many others are available. No particular NSAID has been shown to be more effective for the control of pain than another. However, your doctor may switch you from one NSAID to another to find one that works best for you.


    COX-2 inhibitors, such as celecoxib (Celebrex), are more selective members of NSAIDs. Although increased cost can be a negative factor, the incidence of costly and potentially fatal bleeding in the gastrointestinal tract is clearly less with COX-2 inhibitors than with traditional NSAIDs. Long-term safety (possible increased risk for heart attack or stroke) is currently being evaluated for COX-2 inhibitors and NSAIDs.


    Acetaminophen is considered effective for treating acute pain as well. NSAIDs do have a number of potential side effects, including gastric irritation and kidney damage, with long-term use.


    Muscle relaxants: Muscle spasm is not universally accepted as a cause of back pain, and most relaxants have no effect on muscle spasm. Muscle relaxants may be more effective than a placebo (sugar pill) in treating back pain, but none has been shown to be superior to NSAIDs. No additional benefit is gained by using muscle relaxants in combination with NSAIDs over using NSAIDs alone. Muscle relaxants cause drowsiness in up to 30% of people taking them. Their use is not routinely recommended.


    Opioid analgesics: These drugs are considered an option for pain control in acute back pain. The use of these medications is associated with serious side effects, including dependence, sedation, decreased reaction time, nausea, and clouded judgment. One of the most troublesome side effects is constipation. This occurs in a large percentage of people taking this type of medication for more than a few days. A few studies support their short-term use for temporary pain relief. Their use, however, does not speed recovery.


    Steroids: Oral steroids can be of benefit in treating acute sciatica. Steroid injections into the epidural space have not been found to decrease duration of symptoms or improve function and are not currently recommended for the treatment of acute back pain without sciatica. Benefit in chronic pain with sciatica remains controversial. Injections into the posterior joint spaces, the facets, may be beneficial for people with pain associated with sciatica. Trigger point injections have not been proven helpful in acute back pain. Trigger point injections with a steroid and a local anesthetic may be helpful in chronic back pain. Their use remains controversial.



Low Back Pain Surgery

Surgery is seldom considered for acute back pain unless sciatica or the cauda equina syndrome is present. Surgery is considered useful for people with certain progressive nerve problems caused by herniated discs.


Other Therapy

    Spinal manipulation: Osteopathic or chiropractic manipulation appears to be beneficial in people during the first month of symptoms. Studies on this topic have produced conflicting results. The use of manipulation for people with chronic back pain has been studied as well, also with conflicting results. The effectiveness of this treatment remains unknown. Manipulation has not been found to benefit people with nerve root problems.


    Acupuncture: Current evidence does not support the use of acupuncture for the treatment of acute back pain. Scientifically valid studies are not available. Use of acupuncture remains controversial.


    Transcutaneous electric nerve stimulation (TENS): TENS provides pulses of electrical stimulation through surface electrodes. For acute back pain, there is no proven benefit. Two small studies produced inconclusive results, with a trend toward improvement with TENS. In chronic back pain, there is conflicting evidence regarding its ability to help relieve pain. One study showed a slight advantage at one week for TENS but no difference at three months and beyond. Other studies showed no benefit for TENS at any time. There is no known benefit for sciatica.


    Exercises: In acute back pain, there is currently no evidence that specific back exercises are more effective in improving function and decreasing pain than other conservative therapy. In chronic pain, studies have shown a benefit from the strengthening exercises. Physical therapy can be guided optimally be specialized therapists.