How is acute back pain managed?

Management of acute low back pain ranges from conservative to intensive. Conservative pain management includes prevention, rest (brief), cold packs, pain relievers, muscle relaxants, and physical therapy.

Bedrest may be recommended for 1 to 2 days. During this time, you should not perform tasks that may place strain on your back, such as walking, house cleaning, sitting and lifting. Your doctor may ask you to begin gentle back exercises to keep your back muscles flexible.

Prevention is the most important management technique and even plays a prominent role in rehabilitating people with difficult to treat pain. Prevention methods include:

  • A well-balanced diet
  • Regular exercise program
  • Quitting smoking
  • Weight loss
  • Good body mechanics (posture, lifting heavy objects, workplace evaluation and changes)

When these conservative measures fail to give enough relief, more intensive treatment is needed. These methods include nerve blocks and chronic pain management programs. This occurs in approximately 5% of people with acute back pain.

Intensive pain management

Intensive pain management includes more invasive techniques to relieve pain not relieved by other methods. These techniques have more side effects, potential complications, and are more expensive. They include:

  • Nerve blocks and injections: Medications to treat pain or interfere with nerve function are injected directly into the space surrounding the spinal cord.
  • Intraspinal implants
  • Spinal cord stimulation
  • Intraspinal infusion systems
  • Surgery: Surgery may be done to relieve pressure (decompress) and pain by removing parts of the vertebrae or intervertebral disc that are pressing on the nerves.

Nerve blocks and injections

Nerve blocks and other injections are used to make physical therapy easier, and include:

  • Trigger point injections
  • Epidural steroid injections
  • Facet joint injections or facet nerve blocks
  • Specific nerve root injections
  • Spinal differential nerve blocks

Trigger point injections are used for myofascial pain syndromes. Myofascial pain is sometimes severe muscular pain that may travel to other parts of the body, similar to nerve pain. The muscles become very sensitive and tender. Part of the muscle -- the "trigger point" -- may go into spasm. Injection of medication into a muscular trigger point reduces muscle pain and spasm, and allows a person to resume his or her physical therapy program.

Epidural steroid injections (ESIs) are injections of a short-acting local anesthetic and a long-acting steroid into the epidural space. The epidural space is an area in the spine that contains fat, blood vessels and the spinal nerves covered with membranes. ESIs are usually used for pain from herniated intervertebral disks (radicular pain), spinal canal stenosis and some mechanical back pain.

Sometimes, a caudal (lowest portion of the spine) epidural steroid injection is used as a different approach to ESIs. This approach is most often used for people who have had previous back surgery.

Facet joint injections or facet nerve blocks, and medial branch nerve blocks are other types of blocks that are used for people who have degenerative arthritis of the facet joints, or predominately back pain with minimal leg pain.

Intraspinal implants

Intraspinal implants are available for patients with pain that does not respond to other treatment methods. Implanted devices include:

  • Spinal cord stimulation: This involves placing a small wire attached to a power source to apply electrical impulses to the space surrounding irritated or damaged spinal nerves. The electrical impulses block pain signals from reaching the brain.
  • Intraspinal infusion: Intraspinal infusion uses an implanted pump to deliver a continuous flow of medication to the spaces surrounding the spinal nerves.

These devices require realistic expectations for pain reduction, and need ongoing medical follow-up for revisions, refills and battery changes. Additionally, patients need ongoing behavioral management techniques

Chiropractic adjustment

For some people with whiplash injuries, gentle chiropractic or osteopathic adjustments may help to restore movement, and speed recovery. Chiropractic care focuses on improving motion and diminishing pain caused by a whiplash injury.

Last reviewed by a Cleveland Clinic medical professional on 11/01/2016.


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