Since many types of back pain resolve within 6 weeks, the first approach to treating lower back pain is often aggressive but without the use of procedures that involve any kind of operation. Rest may be recommended or, in some cases, total bed rest not to exceed 2 days. Various combinations of the following options may also be used:

  • Anti-inflammatory medications: Aspirin, ibuprofen, acetaminophen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and reduce inflammation in the short term. Patients with gastritis or a history of ulcers may be prescribed a different type of medication called a COX-2 selective NSAID.
  • Opioids: As a class of medications, opioids are generally more effective pain relievers than NSAIDs, but they usually don’t improve a patient’s psychological state or ability to move. Also, some doctors and patients may be concerned about their addictive potential. Long-term use of muscle relaxants and opioids is discouraged in patients with chronic pain.
  • Antidepressants: Antidepressants (drugs like Paxil ®, Prozac ®, and Wellbutrin ® ) may provide some relief. In clinical trials they have proved more effective than placebo (sham treatment), but their side effects may be limiting. Antidepressants are particularly useful if back pain is accompanied by a mood disorder.
  • Exercise and physical therapy: Broadly speaking, these measures may include stretching, strengthening exercises, and “back school" (a type of patient education). These actions may be better than medical care alone, especially when they are medically supervised. Manipulative therapy—treatment that attempts to adjust parts of the spine by hand or machine—may also have an effect.

    • A recent study involving 349 patients with 2-years of follow-up found no clear evidence that spinal fusion surgery was any more likely to provide good relief of lower back pain than an intensive program of lower back rehabilitation combining social, physical, psychological, and occupational factors.

  • Massage therapy: Massage therapy may decrease symptoms and improve one’s ability to move, especially when combined with exercise and education.
  • Patient education: A back school program to teach neutral spine posture and proper basic movements can be helpful.
  • Spinal injections: Corticosteroids and anesthetics are substances that can be injected in the spinal area to help recovery, but they are not recommended for short-term relief.
  • Smoking cessation: Quitting smokingis highly recommended. Smokers have a higher rate of lower back pain and disc herniations—and they have higher rate of persistent back pain after treatment.
  • Weight loss: A study of active duty military personnel who underwent the IDET* procedure for chronic lower back pain found a relationship between obesity and poor procedure results. Weight loss also reduces physical stress on the discs of the lower back.

The following measures are sometimes used to treat lower back pain, but there is no evidence to suggest they have any real effect:

  • Orthoses (braces and splints that help support the back and restrict movement)
  • Transcutaneous (through the skin) electrical nerve stimulation (TENS)
  • Traction
  • Acupuncture
  • Magnet therapy
  • Injections into trigger points
  • Hydrotherapy

When nonoperative treatment does not work, the next phase of lower back pain management may be minimally invasive treatment.

Prozac ® is a registered trademark of Eli Lilly & Company.
Paxil ® and Wellbutrin ® are registered trade names of GlaxoSmithKline.