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Treatments and drugs

By Mayo Clinic staff

Pain Management Advisor

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Most back pain gets better with a few weeks of home treatment and careful attention. Over-the-counter pain relievers may be all that you need to improve your pain. A short period of bed rest is OK, but more than a couple of days actually does more harm than good. Continue your daily activities as much as you can tolerate. Light activity, such as walking and daily activities of living, is usually OK. But, if an activity increases your pain, stop doing that activity. If home treatments aren't working after several weeks, your doctor may suggest stronger medications or other therapies.

Medications
Your doctor is likely to recommend pain relievers such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve). Both types of medications are effective at relieving back pain. Take these medications as directed by your doctor, because overuse can cause serious side effects. If mild to moderate back pain doesn't get better with over-the-counter pain relievers, your doctor may also prescribe a muscle relaxant. Muscle relaxants can cause dizziness and may make you very sleepy.

Narcotics, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor.

Low doses of certain types of antidepressants — particularly tricyclic antidepressants, such as amitriptyline — have been shown to relieve chronic back pain, independent of their effect on depression.

Education
Right now, there's no commonly accepted program to teach people with back pain how to manage the condition effectively. That means education may be a class, a talk with your doctor, written material or a video. What's important is that education emphasizes the importance of staying active, reducing stress and worry, and teaching ways to avoid future injury. However, it's also important for your doctor to explain that your back pain may recur, especially during the first year after the initial episode, but that the same self-care measures will be able to help again.

Physical therapy and exercise
Physical therapy is the cornerstone of back pain treatment. A physical therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises that may help increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help prevent pain from returning.

Injections
If other measures don't relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than a few months.

In some cases, your doctor may inject numbing medication and cortisone into or near the structures believed to be causing your back pain, such as the facet joints of the vertebrae. Located on the sides, top and bottom of each vertebra, these joints connect the vertebrae to one another and stabilize the spine while still allowing flexibility.

Surgery
Few people ever need surgery for back pain. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you may benefit from surgical intervention. Otherwise, surgery usually is reserved for pain related to structural anatomical problems that haven't responded to intensive conservative therapy measures.

Alternative medicine Tests and diagnosis
References
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DS00171 Sept. 11, 2012

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