Low back pain Treatment options

Low back pain Treatment options vary depending on how long you have had the pain, how severe it is, and your individual needs and preferences.

Short-term back pain

Initially, back pain is usually treated with over-the-counter painkillers and home treatments. Most people will experience a significant improvement in their symptoms within six weeks.

Keep moving

It used to be thought that bed rest would help you recover from a bad back, but it's now recognised that people who remain active are likely to recover more quickly.
This may be difficult at first if the pain is severe, but try to move around as soon as you can and aim to do a little more each day.
Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.

There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity, and it can distract you from the pain.

Painkillers

Paracetamol is often one of the first medications recommended for back pain, although some people find non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, more effective. A stronger painkiller, such as codeine, is also an option and is sometimes taken in addition to paracetamol.

Painkillers can have side effects, some can be addictive and others may not be suitable, depending on your health and medical history. For example, the long-term use of NSAIDs can affect how well your kidneys work.

Your pharmacist or GP will be able to give you advice about the most appropriate type of medication for you.

If over-the-counter medications are not controlling your pain, your GP may be able to prescribe something stronger. They may also recommend a short course of a muscle relaxant, such as diazepam, if you experience muscle spasms in your back.

Hot and cold treatments

Some people find that heat – for example, a hot bath or a hot water bottle placed on the affected area helps ease the pain.

Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area can also be effective. Don't put the ice directly on to your skin though, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth before putting it on your skin.

Another option is to alternate between hot and cold using ice packs and a hot water bottle. Hot and cold compression packs can be bought at most pharmacies.

Relax and stay positive

Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition may make things worse. Read more about relaxation tips to relieve stress.

Although it can be difficult, it's also important to stay optimistic and recognise that your pain should get better because people who manage to stay positive despite their pain tend to recover quicker.

Change your sleeping position

Changing your sleeping position can take some of the strain off your back and ease the pain.

If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing pillows under your knees will help maintain the normal curve of your lower back.

Exercise and lifestyle

Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress.

Regular exercise and being active on a daily basis will help keep your back strong and healthy. Activities such as walking, swimming and yoga are popular choices. The important thing is to choose an enjoyable activity that you can benefit from without feeling pain.

Long-term back pain

If you have had back pain for more than six weeks (known as chronic back pain), your GP will advise you about which painkillers to take and may recommend:

• Exercise classes - group classes supervised by a qualified instructor, where you are taught exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
• Manual therapy - therapies including manipulation, mobilisation and massage, usually carried out by chiropractors, osteopaths or physiotherapists (although chiropractic and osteopathy aren't widely available on the NHS).
• Acupuncture - a treatment where fine needles are inserted at different points in the body. It's been shown to help reduce lower back pain, although it's not always available on the NHS.

These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.

There is also some evidence that a therapy called the Alexander technique may help people with long-term back pain, although the National Institute for Health and Care Excellence (NICE) does not currently recommend this treatment specifically.

Some of the other treatments that may be recommended are described below.

Antidepressants

If painkillers do not help, you may be prescribed tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended to treat depression, but they are also effective at treating some cases of persistent pain.

If you are prescribed a TCA to treat persistent back pain, the dose is likely to be very small.

Counselling

If the treatments described above are not effective, you may be offered psychological therapy to help you deal with your condition.While the pain in your back is very real, how you think and feel about your condition can make it worse. Therapies such as cognitive behavioural therapy (CBT) can help you manage your back pain better by changing how you think about your condition.

Pain clinics

If you have long-term pain, you may be able to attend a specialist pain clinic.Pain clinics help people manage their pain and provide advice about things such as increasing your activity level and how to have a better quality of life despite being in pain.Your programme may involve using a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain.

Surgery

Surgery for back pain is usually only recommended when all other treatment options have failed or if your back pain is so severe you are unable to sleep or carry out your daily activities.The type of surgery suitable for you will depend on the type of back pain you have and its cause.Two procedures sometimes carried out include

• a discectomy -  where part of one of the discs between the bones of the spine (the vertebrae) is removed to stop it pressing on nearby nerves (known as a slipped or prolapsed disc)
• spinal fusion - where two or more vertebrae are joined together with a section of bone to stabilise the spine and reduce pain

These procedures can help reduce pain caused by compressed nerves in your spine, but they are not always successful and you may still have some back pain afterwards.

As with all types of surgical procedures, these operations also carry a risk of potentially serious complications. In some cases, nerves near the spine can be damaged, resulting in problems such as numbness or weakness in a part of one or both legs or, in rare cases, some degree of paralysis.

Before you agree to have surgery, you should fully discuss the risks and benefits with your surgeon.

Treatments not recommended

A number of other treatments have sometimes been used to treat long-term back pain, but are not recommended by The National Institute for Health and Care Excellence (NICE) because of a lack of evidence about their effectiveness in treating non-specific back pain (back pain with no identified cause).

These include:

• low level laser therapy -  where low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair
• interferential therapy (IFT) -  where a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body’s natural painkillers)
• therapeutic ultrasound - where sound waves are directed at your back to accelerate healing and encourage tissue repair.
• transcutaneous electrical nerve stimulation (TENS) - where a machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) that are attached to your skin; the pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain.
• lumbar supports - cushions, pillows and braces used to support your spine.
• traction - where a pulling force is applied to your spine.
• injections - where painkilling medication is injected directly into your back.

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Source : http://www.nhs.uk/Conditions/Back-pain/Pages/Treatment.aspx