How is back pain treated?
Most back pain can be successfully treated with conservative (non-surgical) measures. Conservative treatment includes:
- As much activity (standing, walking, working) as can be tolerated
- Acetaminophen (non-aspirin over-the-counter pain reliever) and/or an anti-inflammatory medication
- Cold packs to diminish swelling and pain
Usually, the pain will subside within 4 to 7 days. If there is no improvement after 4 to 7 days, contact your doctor.
When back pain is chronic, persistent and disabling, a complete treatment approach addressing all aspects of the problem, including psychological as well as physical, offers the best hope for rehabilitation and recovery. A multi-disciplinary treatment team — consisting of a medical physician, physical therapist, psychologist or psychiatrist, and pain management specialist — offers the best hope for return to an active, productive life.
The role of medication in the management of back pain is to relieve symptoms and facilitate an active, exercise-oriented rehabilitation program. An array of new medications is now available to assist in achieving this goal.
The newer anti-inflammatory pain relievers, such as celecoxib, are less likely to cause gastrointestinal side effects, such as nausea or diarrhea.
Some older medications also have been found to help in the treatment of back pain. For example, disruption of sleep by chronic back pain is common. Poor sleep may, in fact, magnify pain. Low doses of traditional anti-depressant medicines, such as doxepin, may reduce pain and improve the quality of sleep.
Anti-convulsants, such as gabapentin, often are helpful for nerve irritation symptoms, such as burning or numbness.
In rare instances, careful use of long-acting opioid pain relievers may improve function and quality of life.
Active, exercise-oriented physical therapy is the cornerstone of treatment for people with chronic back pain. Heat, ice, massage, and ultrasound may provide temporary relief, but rarely provide long-term benefits.
Exercise programs should be individualized by a spine-oriented physical therapist. Typically, the exercise program can be performed at home without special equipment. Follow-up visits with the therapist are necessary to "fine tune" the program. Returning to work in any capacity is strongly recommended.