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Metro Health

Back Pain

Nonsurgical Treatments

Nonsurgical treatments to reduce back pain may include:

Hot or cold: Hot or cold packs – or sometimes a combination of the two – can be soothing to chronically sore, stiff backs.  Heat dilates the blood vessels, both improving the supply of oxygen that the blood takes to the back and reducing muscle spasms.  Heat also alters the sensation of pain.  Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area.  Although cold may feel painful against the skin, it numbs deep pain.  Applying heat or cold may relieve pain, but it does not cure the cause of chronic back pain.

Exercise: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce the risk of it returning.  The following four types of exercise are important to general physical fitness and may  be helpful for certain specific causes of back pain:

           
            Flexion: The purposes of flexion exercises, which are exercises in which you bend forward, are to (1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; (2) stretch muscles of the back and hips; and (3) strengthen abdominal and buttock muscles.  Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine.  One word of caution: If your back pain is caused by herniated disk, check with your doctor before performing flexion exercises because they may increase pressure within in the disk, making the problem worse.
           
           
Extension: With extension, you bend backward.  They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting and raising the trunk, each exercise performed while lying prone.  The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.
           
            Stretching: The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back.  This can reduce back stiffness and improve range of motion.
           
            Aerobic: Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while.  For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week.  Aerobic exercises work the large muscles of the body and include brisk walking, jogging and swimming.  For back problems, you should avoid exercise that requires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the disks and actually do activities if you have disk disease.  If back pain or your fitness level make it impossible to exercise 30 minutes at a time, try three 10-minute sessions to start with and work up to your goal.  But first, speak with your doctor or physical therapist about the safest aerobic exercise for you.

Medications: A wide range of medications are used to treat chronic back pain.  Some are available over the counter.  Others require a doctor’s prescription.  The following are the main types of medications used for back pain.

            Analgesics: Analgesic medications are those designed specifically to relieve pain.  They include over-the-counter acetaminophen and aspirin (Tylenol), as well as prescription narcotics, such as oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin).  Aspirin and acetaminophen are the most commonly used analgesics; narcotics should only be used for a short time for severe pain or pain after surgery.  People with muscular back pain or arthritis pain that is not relieved by medications may find topical analgesics helpful.  These creams, ointments and salves are rubbed directly onto the skin over the site of pain.  They use one or more of a variety of ingredients to east pain.  Topical analgesics include products such as Zostrix, Icy Hot and Bengay.

            NSAIDs: Nosteroidal anti-inflammatory drugs (NSAIDs) are drugs that relieve pain and inflammation, both of which may play a role in some cases of back pain.  NSAIDs include the nonprescription products ibuprofen (Motrin, Advil), ketoprofen (Actron, Orudis KT), and naproxen sodium (Aleve).  More than a dozen others, including a subclass of NSAIDs called COX-2 inhibitors, are available only with a prescription.

All NSAIDs work similarly by blocking substances called prostaglandins that contribute to inflammation and pain.  However, each NSAID is a different chemical, and each has a slightly different effect on the body.

Side effects of all NSAIDs can include stomach upset and stomach ulcers, heartburn, diarrhea and fluid retention; however, COX-2 inhibitors are designed to cause fewer stomach ulcers.  For unknown reasons, some people seem to respond better to one NSAID than another.  It’s important to work with your doctor to choose the one that’s safest and most effective for you.
           
            Other Medications: Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable.  If the cause of back pain is an inflammatory form of arthritis, medications used to treat that specific form of arthritis may be helpful against the pain.

Traction: Traction involves using pulleys and weights to stretch the back.  The rationale behind traction is to pull the vertebrae apart to allow a bulging disk to slip back into place.  Some people experience pain relief while in traction, but that relief is usually only temporary.  Once traction is release, the stretch is not sustained and back pain is likely to return.  There is no scientific evidence that traction provides any long-term benefits for people with back pain.

Corsets and braces: Corsets and braces include a number of devices, such as elastic bands and stiff supports with metal stays, that are designed to limit the motion of the lumbar spine, provide abdominal support and correct posture.  Although these may be appropriate after certain kinds of surgery, there is little, if any, evidence that corsets and braces help treat chronic low back pain.  In fact, by keeping you from using your back muscles, they may actually cause more problems that they solve by causing lower back muscles to weaken from lack of use.

Behavioral modification: Developing a healthy attitude and learning to move your body properly while you do daily activities, particularly those involving heavy lifting, push or pulling, are sometimes part of the treatment plan for people with back pain.  Other behavior changes that might help pain include adopting healthy habits, such as exercise, relaxation and regular sleeping and dropping bad habits, such as smoking and eating poorly.

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