- Exercise, physical therapy and massage can be beneficial. Several studies since the 1990s have shown the importance of physical activity.
- If over-the-counter painkillers aren't effective, doctors can prescribe stronger medication or muscle relaxants. However, some drugs have side effects and/or can be addictive, so medication should be selected with care.
- Injected drugs are also a possibility; steroids can reduce swelling and anesthetics can numb the pain. There has recently been interest in Botox, which can freeze a muscle and prevent spasms. In a 2007 study, 60% of individuals with lower back pain experienced relief from Botox injections.
Standard medicine is only one option for back pain treatment; alternative therapies abound. "Many of the techniques, like chiropractic treatment, are very effective for relieving a back pain spasm episode," says Dr. Aaron Filler, a Santa Monica, California, spinal surgeon.
- Chiropractic is one of the most common options. There are more than 60,000 licensed chiropractors in the United States, according to the American Chiropractic Assn., based in Arlington, Va.
A chiropractor's favorite technique is spinal adjustment, usually done by hand. The chiropractor puts pressure on a particular spinal segment to push it back into the proper position. Studies show the treatment is safe and effective.
In addition to adjustment, chiropractors may apply cold or hot packs to reduce pain, swelling and inflammation during the procedure. They may also use electrical stimulation or ultrasound to reduce swelling, increase circulation or warm stiff joints.
- A still unproven treatment, prolotherapy, involves injection of a sugar solution into the back to cause growth of the ligaments and tendons that support the spine. The sugar acts as an irritant and promotes inflammation, which leads to increased blood flow for the tissues. Basically, the idea is to toughen up the back.
Prolotherapy is most commonly provided by chiropractors and osteopaths. Supposedly, the ancient Greek physician Hippocrates used a similar technique (although he wielded a hot poker, not sugar water), and it was used for hernias in the 19th century. . A 2008 Cochrane review found little evidence for or against the treatment.
- Some people with back pain turn to traditional Chinese medicine. Acupuncture for back pain is fast acting and decreases the need for medication, says practitioner Jennifer Dubowsky of Chicago. It does not interfere with other treatments, she notes, so is a good partner for other therapies.
Scientific studies have shown that acupuncture is safe and has some effect on pain, although generally a small one.
- Whatever their training or methods, health professionals agree that back pain can cause depression or anxiety. "There's nearly a 100% correlation between chronic and recurrent pain and some degree of depression," says chiropractor Robert Hayden of Griffin, Ga. Anxiety can be a particular problem for a family breadwinner, whose inability to work threatens the family's security. But a person's mental state can also affect pain perception, so negative feelings can make pain feel worse.
Another theory holds that the mind itself is primarily responsible for back pain. Dr. John Sarno, a physician at the Rusk Institute of Rehabilitation Medicine in New York City, is the author of several books about how negative emotions, lurking in the subconscious, can cause the pain he calls tension myoneural syndrome.
Experts agree that it's important for doctors to consider the whole patient in developing treatments that may include therapy or antidepressant medications. "Sometimes, if you only treat the physical problem, you'll miss the primary diagnosis," Hayden says. "It's all interrelated."