The goals of treating lower back pain are usually to both reduce pain and to improve one’s ability to function and engage in activities of daily living.
For acute flareups of pain, a short period or rest or reduced activity may be recommended, but prolonged rest is usually counterproductive.
To address the underlying cause of pain, some type of therapy that creates a better healing environment and actively rehabilitates the spine will almost always be prescribed alongside pain-relieving treatments.
Low back pain is most often managed through a combination of treatments, lifestyle changes and exercise.
For some people, surgery may be an option.
The types of treatment that are most effective for you will be determined by your diagnosis, overall health and personal preferences.
For the vast majority of types of low back pain, the first line of treatment is physical therapy.
The goals of physical therapy are to reduce pain and improve function and a good physical rehabilitation program will be progressive, controlled and guided by a physical therapist, physiatrist, chiropractor, or other qualified health professional. Almost everyone can benefit from stretching muscles in the low back, buttocks, hips and legs. The more mobile these muscles are, the more the back can move without injury. For example, stretching the hamstring muscles in the back of the legs reduces the stress across the low back.
Pain medications may become necessary depending on the level of your pain. The purpose of the medication is to help control your pain so that you can then participate actively in your physical therapy program. There are different types of medications that are used for different situations. Most commonly mild pain can be managed with Tylenol or acetaminophen or over the counter anti-inflammatories can be used. If the pain is more severe than oral steroids and muscle relaxants may be used. If the pain is severe, then sometimes a opioid medication may be required.
So I'd like to tell you just a little bit more about a few of these ways to control your pain.
Ice therapy is surprisingly effective. To protect your skin, place a towel or other dry material such as a t-shirt between your skin and the ice pack, and apply the ice for 10 to 20 minutes at a time. Ice therapy can be used after physical therapy and exercise to reduce activity related pain and inflammation.
If some of the treatments that I've already mentioned don't help reduce your pain enough to proceed with physical therapy, sometimes a selective injection can be used.
There are different types of selective injections and they're all done under x ray guidance or with the use of ultrasound so that the doctor can see exactly where the medication is going and it makes the procedure safe. There are different types of injections, and one of which is an epidural injection. And this type of injection helps get medicine around the nerves themselves.
Now, if the pain is also coming from the facet joints, the joints in the back of the spine, a needle injection targeted directly at that joint can be used to help reduce pain from the facet.
On the other hand, if the pain is coming from the nerve which is going down the leg and causing a lot of leg pain, then the medication may be placed around the individual nerve and that's called a selective nerve root block.
The other location the pain may be coming from is the sacroiliac joint. The sacroiliac joint is located between your sacrum and your hip. That joint can get inflamed and also cause pain.
In addition to physical therapy, there are other approaches that can help reduce pain, in a smaller way help calm the inflammation around a painful disc. These approaches include a tens unit, manual manipulation and therapeutic massage. Warm packs or heat may be applied prior to physical therapy to warm up the lower back muscles and ice therapy used after to reduce inflammation and soreness.
Depending on the diagnosis and the severity of pain and dysfunction, an implanted spinal cord stimulator may be an option. Prior to implantation, a trial procedure is done to see if the spinal cord stimulator will effectively relieve a patient's pain.
Surgery to anatomically remove the source of pain may also be an option. The types of surgery range from minimally invasive to major surgery.
If your pain is severe and is continued for more than 3 to 6 months despite non-surgical treatments, it may be time to consider consulting a spine surgeon about your options.
While all of the things I've talked about are the most common treatment approaches for lower back pain, there are many additional approaches that have been shown to be effective in managing pain. Examples include back braces, acupuncture, yoga, tai chi, nutrition and supplements that reduce inflammation. Other treatments include water therapy or swimming and ergonomic and lifestyle changes.
Clearly, there are many approaches to treat your low back pain. For most people, finding what works best is a process of trial and error, and it includes a multifaceted approach. As always, this video is for your educational purposes only, and please be sure to work closely with your personal health care team to find what works best for you.
In This Article:
Common Medical Treatments for Pain Relief
The most common medical treatments for lower back pain include:
Muscle relaxants
This medication acts as a depressant of the central nervous system and increases mobility of tense muscles, relieving pain caused by muscle spasm and tightness. Muscle relaxants are used for acute pain, and have no role in chronic pain management.
Narcotic pain medications
Narcotic medications may be used for managing intense, short-term pain after surgical procedures.
Narcotic medications, also called opioids or painkillers, alter the brain’s ability to perceive pain by weakening the pain signals. Narcotic medications are most often prescribed only for intense, short-term pain, such as acute pain after an operation. Narcotics are not usually recommended for long-term pain, as they have significant adverse side effects and can easily become addictive.
Back braces
Back braces provide support and stability for the lower back.
Some patients find that a lower back brace provides stability that in turn reduces pain. There is some evidence that use of an inelastic corset-style brace, worn daily, in combination with a physical therapy exercise program, can speed healing and reduce pain.1Morrisette D, Cholewicki J, Logan S, Seif G, McGowan S. A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of low back pain. Spine (Phila Pa 1976). 2014 October 1; 39(21):1733-42
A back brace may also be used to provide stability for the lower back while healing from back surgery.
Injections
The goal of most injections is to provide enough immediate pain relief to allow active participation in physical therapy. Injections are also commonly used to confirm a diagnosis of the cause of pain. Examples of common injections include a lumbar epidural steroid injection, facet joint injection, medial branch nerve block, and selective nerve block.
Ablation
This type of procedure does not inject medication into the spine; rather, a probe is inserted into the spine to destroy a nerve by heating it, thereby eliminating the pain signals. Examples of common ablation techniques include radiofrequency ablation (RFA) for facet joint pain, and basivertebral nerve ablation (BVN) for vertebrogenic back pain.
Manual manipulation
Manual manipulation aims to improve mobility and reduce stiffness in the lower back.
Manual spinal manipulation involves making physical adjustments to the spine with the goals of improving mobility and reducing stiffness, discomfort, or pain. Hand thrusts to adjust the spinal structures can be done with low velocity or high velocity, depending on the patient’s condition and preferences. Manual manipulation has been found to relieve low back pain in some people.2Furlan A, Tazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. Evidence Report/Technology Assessment No. 194. AHRQ Publication No. 10(11) E007. Rockville, MD; Agency for Healthcare Research and Quality. October 2010. Accessed July 13, 2016.
Acupuncture
Acupuncture may provide relief from back pain in some cases.
The approach in acupuncture is to stimulate points on the body using ultra-fine needs needles placed in specific areas of the skin. Acupuncture has been shown to provide significant pain relief for some people.2Furlan A, Tazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. Evidence Report/Technology Assessment No. 194. AHRQ Publication No. 10(11) E007. Rockville, MD; Agency for Healthcare Research and Quality. October 2010. Accessed July 13, 2016.
Massage therapy
Massage may help loosen tight muscles and alleviate low back pain.
When applied to the low back, massage therapy can relieve the muscle spasms that usually contribute to low back pain. Massage also increases blood flow to the low back, which speeds up healing by bringing nutrients and oxygen to damaged muscles.
Mindful meditation
Meditation may help reduce pain perception and alleviate symptoms of depression and anxiety.
Meditation tends to be helpful in reducing the perception of pain, and can also reduce depression, anxiety and sleep problems that commonly occur with chronic pain. Meditative techniques for pain reduction include everything from deep breathing exercises to an altered focus approach.
The above is not a comprehensive list; there are many more treatment choices available, including newer and less invasive surgical options.
- 1 Morrisette D, Cholewicki J, Logan S, Seif G, McGowan S. A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of low back pain. Spine (Phila Pa 1976). 2014 October 1; 39(21):1733-42
- 2 Furlan A, Tazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. Evidence Report/Technology Assessment No. 194. AHRQ Publication No. 10(11) E007. Rockville, MD; Agency for Healthcare Research and Quality. October 2010. Accessed July 13, 2016.
