Back Pain - Treatment 

Generally, back pain is categorized in two ways as described below. 

• Acute -  where back pain occurs suddenly and lasts  for less than three months. 
• Chronic -  where  back pain develops gradually, over time, lasts for more than 12 weeks, and causes long-term problems. 

However, most people with lower back pain experience mild pain and have occasional bouts  of pain that are more severe. This can make it difficult to determine whether their  back pain is acute  or chronic. 

Treating acute back pain 

Most cases of acute back pain can be treated using self-help techniques. These  are discussed below. 

Over-the-counter (OTC) painkillers 

Paracetamol is  usually recommended to treat acute lower back pain. If paracetamol proves ineffective, a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used instead. 

Stronger painkillers 

If your back pain symptoms  are severe, your physician may prescribe a mild opiate-based painkiller, such as codeine, which can be taken in combination with paracetamol or a NSAID. 

Muscle relaxants 

If your back pain symptoms are very severe, your physician may prescribe a muscle relaxant such as diazepam. 

Diazepam can make you feel very sleepy, so do not drive if you have been prescribed this medication. After your course  of diazepam has ended, you should wait at least 24 hours before driving. Diazepam will also make the effects of alcohol worse, so you should avoid alcohol while you are taking the medication. 

Diazepam has the potential to be habit-forming, and can cause a number of unpleasant withdrawal symptoms when coming of the medication. To minimise these effects, your physician will not usually prescribe more than seven days worth of the medicine. 

Exercise 

It's important to remain as physically active as possible. While bed rest may provide some temporary relief from your symptoms, prolonged bed rest will make your symptoms worse. 

Recommended exercises  for back pain include walking and gentle stretching. 

Your back pain may be so severe that you need to have some time off work. However, if this is the case, you should aim to return to work as soon as possible. While you may not feel any immediate benefit, research has shown the people who continue to work during an episode of back pain recover quicker than people who stay at home. 

Compression packs 

Many people with back pain find that using either hot  or cold compression packs helps reduce pain. You can make you own  cold compression pack by wrapping a bag of frozen food in a towel. Hot compression  packs are often available from larger pharmacies. You  may find it useful to use one type of pack after the other. 

Treating chronic back pain 

This will usually require a combination of self-help techniques and medical treatment. Treatment options are discussed below. 

Analgesics (painkillers)

As with acute back  pain, painkillers are usually  the first method  of treatment for  chronic back pain. Initially, it is likely that paracetamol will be recommended, but if your back pain is severe, codeine may be prescribed. 

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, should only be used for long periods under the advice of your physician.  If long-term treatment using NSAIDs is required, your physician may prescribe gastro-protective medicines, such as proton pump inhibitors (PPIs). 

Amitriptyline

If your back pain is severe and does not improve with the use of painkillers, your physician may recommend a one-month trial of a medication called amitriptyline. Amitriptyline is usually used to treat depression,  but it has also been found to be useful in treating nerve pain. 

If you are prescribed a course of amitriptyline, you may experience some side effects including: 

• drowsiness, 
• dry mouth, 
• blurred vision, 
• constipation, and 
• Difficulty urinating. 

You  should not drive if you are taking amitriptyline and it is making you drowsy. 

Amitriptyline should not  be taken by people with a history of heart disease. 

Exercise 

As with  acute back pain, if you have chronic back pain, you should try to remain as physically active as possible because doing so will reduce the severity of your symptoms. It is also recommended that you continue working,  or return to work as soon as possible. 

Regular exercise will help to strengthen the muscles that support your back. Exercise also promotes the production of endorphins, which are natural painkilling chemicals. Ask your physician for advice about a suitable exercise plan for you. 

Bending, twisting, or placing strain on your back  can be painful. However, excessively protecting your back can delay return to normal activities. The trick is to be careful when making potentially painful movements, but to pace your return to full normal activity. 

Physiotherapy 

If  you have chronic back pain, Your physician may refer you to a physiotherapist - a qualified specialist who will be able to help you to improve your range of movement.  A physiotherapist will be able to teach you exercises that strengthen the muscles that support your back, as well as improving  the flexibility  of your spine. They can also teach you how  to improve your posture and reduce any future strain on your back. 

Cognitive behavioural therapy (CBT) 

Some studies have shown that a type of therapy called cognitive behavioural therapy (CBT) can help in  the management  of chronic  back pain.

CBT is based on the principle that the way you feel is partly dependent on the way that you think about things. Studies have shown that people who train themselves to react differently to pain, by using relaxation techniques  and maintaining a positive attitude, report that their levels of  pain went down. 

They were also more likely to remain active  and take exercise, further reducing  the severity  of their symptoms. 

Surgery 

Surgery may be an option to treat cases of chronic back  pain when: 

• there is an identifiable cause,  such as a ruptured herniated disc
• the symptoms  have not responded to other forms of treatment, and 
• the symptoms are getting progressively worse. 

The type of surgery that will be recommended will depend on the cause of your  back pain. Some surgical options are listed below. 

• Discectomy -  where the part of the herniated disc that  is pressing on your nerve is removed. 
• Fusion surgery -  if a vertebra has slipped out of place, it may be possible to fuse it into place using metal rods. 
• Injections -  a variety of injections are available that a surgeon can make into your  back in order to help relieve the  pain.

As with all surgical procedures, spinal surgery carries some risks. For example, following surgery, there is a 10% chance of infection. If this occurs, further surgery may be required to clean out the infection, although some cases can be treated with antibiotics. 

In the case of fusion surgery, there is a 1-2% chance of the vertebrae failing to fuse into place. If this occurs, further surgery will be required. 

There is a very low risk that your spinal cord will be damaged during surgery. The chances of this happening are estimated  to be six in 1,000 (0.6%). In the rare situation that the spinal cord is damaged during surgery, it could result in problems ranging from some muscle weakness to total paralysis. Your bladder  and bowel control may also be affected. 

Before having back surgery, your surgeon will be able to fully discuss the risks and benefits of the procedure  with you. 

Complementary therapies 

Some people with back pain choose to use complementary therapies alongside more conventional treatments, while others choose to use them as stand-alone treatments 

Complementary therapies such as chiropractic, osteopathy, shiatsu and acupuncture may help to ease  your back pain, and encourage  you to feel relaxed. 

An osteopath is a health professional who specialises in treating the skeleton  and muscles, and chiropractor treats joint, muscle and bone problems, focusing on the spine. 
Shiatsu is a traditional Japanese technique that is often described as 'finger pressure' therapy. It is a form of massage that works by applying pressure to energy lines in your body. A shiatsu therapist will use their fingers, thumbs and elbows to carry out the treatment. 

Acupuncture is a form of traditional Chinese medicine which involves the insertion of very fine needles at key points in the body. This  can help encourage the body to release its natural form of painkillers, known as endorphins. It can also help to stimulate nerve  and muscle tissue. 

For many complementary therapies, clinical studies have  not produced conclusive evidence as to their safety and effectiveness. Therefore, if you are considering using a complementary therapy, you should carefully weigh up any benefits and potential risks and discuss it with your GP if you are uncertain. 

Transcutaneous electrical nerve stimulation (TENS) 

The transcutaneous electrical nerve stimulation (TENS) machine is an increasingly popular treatment method for people with long-term back pain. The machine delivers small electric pulses to your body through electrodes that are placed on your skin. 

It is thought that these pulses work in two ways. A low electric pulse can encourage your body to produce more endorphins - the body's own painkilling chemical. A high electric pulse can also block pain signals going from your back to your brain. 

Many medical studies have been carried out on the use of TENS but the results have been conflicting. Some studies  suggest that the machines are of little use, while other studies suggest that they may be able  to help certain people. 

You should only use a TENS machine under the direction of  your physician or other healthcare professional. 

The following people should avoid using a TENS machine: 

• pregnant women - unless specifically advised to by their doctor, 
• people with epilepsy, 
• people who have a pacemaker fitted, and 
• People with a history of heart disease.