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What works best for relieving back pain?

The Bottom Line

  • Low back pain is one of the most common medical conditions among adults and can cause distress, disability and a diminished quality of life.
  • Non-drug therapies including exercise, yoga, mindfulness, massage and acupuncture can help relieve back pain and are recommended as a first line of treatment.
  • If non-drug approaches are not enough, NSAIDs or the antidepressant duloxetine may help reduce back pain. Acetaminophen does not help relieve acute back pain.
  • Opioids have high risks of harm and should be prescribed with caution.

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.


Non-drug therapies

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.


Medication options

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.

Featured Resources

Web Resource Rating: 5 Strengthening exercises for lower back pain


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References

  1. Hoy D, March L, Brooks P. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73(6): 968-974. doi: 10.1136/annrheumdis-2013-204428. 
  2. Chou R, Deyo R, Friedly J et al. Non-pharmacologic therapies for low back pain: A systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med. 2017; 166(7):493-505. doi: 10.7236/M16-2459
  3. Searle A, Spink M, Ho A, et al. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabili. 2015; 29(12):1155-1167. doi: 10.1177/0269215515570379. 
  4. Cramer H, Lauche R, Haller H, et al. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013; 29(5):450-460. Doi: 10.1097/AP.0b013e31825e1492.
  5. Ivanova JL, Bimbaum HG, Schiller M et al. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care. Spine J. 2011; 11(7):622-632. doi: 10.1016/j.spinee.2011.03.017.
  6. Chou R, Deyo R, Friedly J et al. Systematic pharmacologic therapies for low back pain: A systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med. 2017; 166(7):480-492. doi: 10.7326/M16-2458.
  7. Chou R, Turner JA, Devine EB et al. The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015; 162(4):276-286. doi: 10.7326/M14-2559.
  8. Enthoven WT, Roelofs PD, Deyo RA, et al. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016; 2:CD012087.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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