Treatment Overview

A wide range of treatment is available for low back pain, depending on what is causing the pain and how long it lasts. Most people find that their low back pain improves within a few weeks. Chances are good that your pain will go away soon with some basic self-care.

As you consider treatment for your low back pain, keep the following in mind:

• If you have recently developed low back pain, stay active and consider taking over-the-counter pain medicines such as acetaminophen (Tylenol, for example) or nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs are ibuprofen (Advil or Motrin) and naproxen (Aleve or Naprosyn). Staying active is better for you than bed rest. In fact, staying in bed more than 1 or 2 days can actually make your pain worse and lead to other problems such as stiff joints and muscle weakness.²
• Research shows that people who understand their low back pain are more satisfied.³ Be sure to ask your doctor or physical therapist if you have questions about your symptoms, how to manage your back pain, or activities you can do or should not do.
• If your low back pain has lasted longer than 3 months, you will probably benefit from more intensive treatment. Programs that combine strengthening exercises with education and activities to help you increase your function and manage your pain are often effective.⁴
• Surgery is rarely needed for low back pain. Even if you have a herniated disc or nerve damage, you are likely to improve without surgery.
• After you have had low back pain once, the pain is likely to come back. To avoid further problems, keep your back and stomach muscles strong, use good posture, learn the safest way to lift heavy objects, and learn to manage stress.

Treatment for acute low back pain

Acute low back pain is pain that has lasted less than 3 months. If you have recently started to have low back pain, there's a good chance that it will get better within a few weeks. Most low back pain will improve if you take the following steps:

• For the first day or two, rest in a comfortable position. Try lying on your side with a pillow between your knees. Or lie on your back on the floor with a pillow under your knees. Do not stay in one position for too long, though. Every 2 or 3 hours, take a short walk (about 10 to 20 minutes), then find a comfortable position to rest again.
• Take pain medicine if needed, such as acetaminophen (Tylenol) or medicines that reduce pain, swelling, and irritation, including ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve or Naprosyn). These medicines usually work best if you take them on a regular schedule instead of waiting until the pain is severe.
• Try using a heating pad on a low or medium setting, or a warm shower, for 15 to 20 minutes every 2 to 3 hours. Or you can buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help, but you can try them to see if they help. You may also want to try switching between heat and cold.
• As soon as possible, get back to your normal activities. Movement helps your muscles stay strong. Staying in bed for more than 1 or 2 days can actually make your problem worse.

Walking is the simplest and perhaps the best exercise for the low back. Your doctor or a physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. The muscles of your trunk, or core, support your spine. Strengthening these muscles can improve your posture, keep your body in better balance, and decrease your chance of injury. For more information, see:

Fitness: Increasing core stability.

Most people have at least one repeat episode of low back pain. If you have had low back pain, remember that your back is now more vulnerable than before. Keep your stomach and back muscles strong, lift properly, and use good posture. For more information, see:

Low back pain: Exercises to reduce pain.

Back problems: Proper lifting.

One treatment choice for acute low back pain is spinal manipulation, or spinal manual therapy. The aim of spinal manipulation is to increase a joint's range of motion. Spinal manipulation can be done by a chiropractor, osteopathic doctor, and some physical therapists or physiatrists. For more information on this type of treatment, see:

Should I have spinal manipulative therapy to treat low back pain?

New research suggests that a brief program of instruction in pain management—addressing how to manage usual daily activities, how to deal with worries about back pain, and overcoming fear of causing pain—can also be an effective treatment for low back pain.⁵

Treatment for ongoing (chronic) low back pain

Chronic low back pain is pain that has lasted longer than 3 months. As low back pain continues beyond 3 months, it becomes vitally important that you develop skills for managing and coping with chronic pain so you can avoid getting into a cycle of sleeplessness, inactivity, irritability, depression, and more pain.

Chronic pain often requires both psychological counseling and medical treatment, because pain has a wearing effect on both the mind and the body. Seek out a cognitive-behavioral therapist who can teach you stress management and pain control skills. Look for a "back school" program and at least one type of health professional who specializes in spinal care. The most successful programs are usually those that combine exercise, activities to increase your function, and techniques to help you manage pain.⁴ Depending on your condition, you can start taking charge of pain by continuing with home treatment measures and using one or more of the following treatments:

• Daily exercises to strengthen your trunk and back. See a physical therapist for specific exercises. For more information, see:

  Fitness: Increasing core stability. One study suggests that this type of exercise may be more effective than either manual therapy or education as a part of physical therapy for chronic low back pain.⁶

  Low back pain: Exercises to reduce pain.

• Medicines, if needed. They are not effective for all people, but medicines that doctors sometimes suggest for low back pain include:
  • Acetaminophen to reduce pain and/or medicines that reduce pain, swelling, and irritation, including ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn). These medicines usually work best if you take them on a regular schedule instead of waiting until the pain is severe.
  • Prescription pain medicine or muscle relaxants for a short time, to help break the pain cycle.
  • Antidepressants, to treat chronic pain. This type of medicine not only treats depression but may have an additional effect on chronic pain.
  • Anesthetic or corticosteroid injections, to block pain sensation or reduce inflammation.
• Other therapies. These may include:
  • Heat and/or ice, depending on which seems to help you more. You may want to try switching between heat and cold.
  • Therapeutic massage, to ease muscle spasm.
  • Spine adjustment (manipulation), by an osteopath, chiropractor, physiatrist, or a physical therapy spine specialist. People who benefit from this usually notice improvement after one visit, and additional manipulation may not be needed.⁷
  • Cognitive-behavioral therapy or biofeedback, for controlling pain and pain triggers. See a psychologist, licensed counselor, or clinical social worker who specializes in pain management skills.
  • Acupuncture, which may help decrease pain and increase activity. Some studies show that acupuncture reduced pain and disability related to back problems more than usual treatment.^{8, 9} In contrast, a summary of several studies showed that acupuncture reduced pain and increased the ability to be active, but not any more than other treatments.¹⁰

Several experimental treatments are controversial, with little evidence that they help. These include:

• A traction-like treatment called vertebral axial decompression.
• Percutaneous disc decompression such as intradiscal electrothermic therapy (IDET).
• Radiofrequency ablation for facet joint pain.
• Botulinum (Botox) injection.
• Prolotherapy.

Facet joint injections and spinal traction are not considered to be safe and effective treatments for chronic low back pain.⁴

Treatment if low back pain gets worse or comes back

See your doctor if you have moderate to severe low back pain that lasts more than a couple of days; if you have back or leg symptoms that have gotten worse; if your symptoms have not gone away after 2 weeks of home treatment; or if improved symptoms flare up again. A physical exam and possibly an imaging test may produce new information about your condition and help direct your treatment decisions.

• If no serious cause of mild to moderate low back pain is apparent (as in 85% of cases), your doctor will probably advise you to continue with home treatment.¹¹ Consider seeing a physical therapist for back-healthy exercises to use every day, as long as they don't make your symptoms worse. A medicine to reduce pain, moist heat application, massage, cognitive-behavioral therapy, learning how to best use your back in a "back school" program, chiropractic therapy (also called spinal manipulation), or biofeedback may also help prevent your symptoms from becoming chronic.
• If your pain is severe, your doctor may recommend short-term use of an opiate painkiller, epidural steroid injection, or muscle relaxant. These medicines have potential harms and side effects, but these may be balanced out if the medicines help you. Epidural steroid injections are usually used only for people with symptoms from a herniated disc, such as pain in the buttocks and down into the leg. Talk with your doctor about the expected benefits and side effects of any medicine.
• If your pain is caused by another health problem, such as a herniated disc, spinal stenosis, ankylosing spondylitis, osteoarthritis, cancer, or infection, your doctor will make specific treatment recommendations.

If you have a herniated disc, your doctor may recommend surgery. Most doctors will wait to consider surgery until after you have tried nonsurgical treatment for 1 to 3 months without improvement (but usually before more than 6 months have gone by). Surgery is eventually considered for about 1 out of 10 people who have a herniated disc.¹² For more information, see:

Should I have surgery for a herniated disc?

For more information about specific conditions, see:

• Lumbar Spinal Stenosis.
• Ankylosing Spondylitis.
• Osteoarthritis.
• Herniated Disc.

At one time, traction was a common treatment for low back pain. Traction was thought to stretch the spine and reduce pressure on the spinal discs. Recent research does not prove that traction will reduce acute or chronic low back pain.^{2, 4}