If you suffer from a bad back, you’re not suffering alone: low back pain is the leading cause of discomfort and disability in the world and the prevalence peaks in older age (1). But that startling bit of trivia is cold comfort when you’re laid up with a stiff, sore and aching back.
However, there are ways to get relief. Here are some treatments and strategies that show promise for reducing pain and disability caused by low back pain. Click on the links to read the research evidence.
Remedies that don’t involve drugs (which come with the risk of side effects) are often the first line of defense when it comes to pain relief, particularly for chronic, long term low back pain. A recent systematic review assessed the impact of various types of therapies on pain levels and function in adults with low back pain (2). The good news is that many of them really do help – at least in the short term – and can reduce pain by a small to moderate amount.
The greatest effects were observed when participants practiced yoga and other types of motor control exercises (e.g. Tai Chi), or engaged in relaxation/stress reduction techniques. There was also evidence that acupuncture, massage and rehabilitation can help relieve pain (2).
This review reinforces recommendations that people experiencing back pain should move, stretch and perform certain types of exercise – even though their inclination might be to just rest. Other studies have shown that strength/resistance training (3), balance/coordination exercises and yoga (4) help to alleviate back pain, strengthen muscles and improve mobility.
Over the years, various types of pain killers and muscle relaxants have been prescribed for chronic low back pain, but they don’t consistently work well for everyone or help avoid the risks of back surgery (5). Recently, valuable new evidence came out of a systematic review that examined the effectiveness of eight different classifications of drugs in reducing low back pain (6). For people who do not respond to non-drug approaches (which are recommended as a first line of treatment), the recommendation is to try NSAIDS (non-steroidal anti-inflammatory drugs) for either acute or chronic pain. As a second choice, duloxetine, a type of antidepressant, was shown to help relieve chronic back pain.
Opioids may also help reduce back pain, but have higher risks of side effects, addiction and overdose. While the included studies did not assess risks for harm, the review authors acknowledge the concerns and controversy surrounding the use of opioids for chronic pain (6;7).
The review also found that acetaminophen does not relieve acute back pain and that NSAIDs are not as effective as previously believed (6), which is consistent with other recent studies. Some types of NSAIDs may be more effective than others (for example, recent research shows “nonselective” NSAIDs have more risks and fewer benefits) (8). Ask your doctor or pharmacist what type of medications you are prescribed for your pain and advice about weighing the risks vs. benefits for your situation.
Have a ‘back up’ plan
Although low back pain afflicts the majority of adults, so far there is no magic cure that will work for all. The best strategy may involve a combination of non-drug therapies, with or without a prescription drug. Work with your doctor to develop a personalized plan for managing your back pain and getting on with your active life.