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Treatments and drugs
By Mayo Clinic staffMost back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of 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. If home treatments aren't working, your doctor may suggest stronger medications or other therapy.
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, others). If mild to moderate back pain doesn't get better with over-the-counter pain relievers, your doctor may also prescribe a muscle relaxant.
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.
Physical therapy and exercise
A physical therapist can apply a variety of treatments, such as heat, ice, 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 to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will 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.
Types of back surgery include:
- Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A bone graft is inserted between the two vertebrae, which may then be splinted together with metal plates, screws or cages. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae.
- Partial removal of disk. If disk material is pressing or squeezing a nerve, your doctor may be able to remove just the portion of the disk that's causing the problem.
- Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, surgeons can remove a small section of the offending vertebra, to open up the passage.
- Devereaux M. Low back pain. Medical Clinics of North America. 2009;93:477.
- Wheeler SG, et al. Approach to the diagnosis and evaluation of low back pain in adults. http://www.uptodate.com/home/index.html. Accessed Dec. 17, 2009.
- Kohatsu W. Low back pain. In: Rakel RE. Integrative Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/175588812-4/930351402/1494/110.html#4-u1.0-B978-1-4160-2954-0..50067-3_3269. Accessed Dec. 17, 2009.
- Knight CL, et al. Treatment of acute low back pain. http://www.uptodate.com/home/index.html. Accessed Dec. 17, 2009.
- Last A, et al. Chronic low back pain: Evaluation and management. American Family Physician. 2009;79:1067.
- Chou R. Subacute and chronic low back pain: Pharmacologic and noninterventional treatment. http://www.uptodate.com/home/index.html. Accessed Dec. 17, 2009.
- Yoga for health: An introduction. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/yoga/introduction.htm. Accessed Dec. 17, 2009.
- Low back pain fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#119483102. Accessed Dec. 17, 2009.
- Laskowski ER (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 26, 2009.
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