You have no doubt heard the saying “misery loves company.” If you find yourself sidelined by the pain of an aching back, rest assured you have company—back pain will affect virtually all adults at some time during their lives (though the saying probably rings hollow if you’re suffering right now). Whether you’re plagued by a new episode of back pain or are struggling with a recurrent problem, there is good news: About 90 percent of people with acute back problems will feel much better in four to six weeks with simple treatments and exercise and temporary modification of activity.
Unless your back pain is caused by a serious medical condition such as a tumor, infection, fracture or nerve damage, conditions that are not common, you can expect a relatively rapid recovery.
If back pain is getting you down, here are the steps you can take to start feeling better.
Ease the pain with medication
This is where nearly all of my patients start: “How can I ease the pain?” Thankfully, that does not usually mean prescriptions or anything with a risk of addiction. Over-the-counter analgesics are usually sufficient to do the job.
Acetaminophen (Tylenol) is widely considered to be the safest effective medication for acute back problems. Nonsteroidal anti-inflammatory drugs, or NSAIDs—including aspirin, ibuprofen (Motrin) and Naproxen (Aleve)—are also effective though they can cause stomach irritation. Acetaminophen may be used safely in combination with NSAIDs.
Patients often think that muscle relaxants are a good option for relieving their back pain, but that’s not the case. Muscle relaxants are no more effective than NSAIDs for treating back symptoms, and using them in combination with NSAIDs has no demonstrated benefit. Because side effects such as drowsiness occur in up to 30 percent of people taking muscle relaxants, it’s best to avoid these drugs if possible.
Similarly, opioids (narcotics) appear no more effective than safer analgesics for managing back pain symptoms. Avoid taking opioids if possible, and if an opioid is prescribed by your doctor, use it only for a short time. Opioids carry a host of potentially dangerous side effects, including drowsiness, decreased reaction time, clouded judgment and the potential for dependence.
Beyond medication, many back pain sufferers find that applying heat or cold packs also help: 20 minutes at a time, several times a day, as often as you can manage.
Try exercises and low-impact activities
Moving might be the last thing on your mind if you are in pain, but flexibility and strong muscles to support your back are just what is needed.
You may be surprised to know that formal physical therapy—such as massage, ultrasound, cutaneous laser treatment, biofeedback and transcutaneous electrical nerve stimulation—has not been proved to resolve acute back symptoms. The same goes for acupuncture and injection procedures (trigger points).
Instead, consider certain safe exercises, which your doctor can suggest and describe how to do correctly, two to three times a day. Exercises are an important way to achieve flexibility and strengthen the muscles that support your back. Although starting back exercises or stretching immediately after a new episode of back pain might temporarily increase your pain, such exercise might reduce the total duration of your pain and prevent recurrences—so don’t give up. If you have frequent episodes of back pain, you should continue exercises indefinitely to prevent new episodes.
I recommend to my patients activities such as walking, swimming and stationary cycling. Within the first two weeks of symptoms, you can begin to gradually increase the amount of time you exercise up to 30 minutes daily.
But be sure to avoid activities that involve twisting or bending or are high-impact. (Sit-ups, for example, are more stressful to the back than aerobic exercise and are not recommended during the first few weeks of symptoms.) Despite the television ads to the contrary, back exercise machines are not effective for treating acute back problems.
To increase comfort during normal daily activity, using shoe insoles during any prolonged standing can help relieve pain. Back corsets and back belts, however, have not been proved to be beneficial for treating acute back symptoms.
Don’t take to your bed
Bed rest and inactivity aren’t helpful for counteracting back pain. In fact, prolonged inactivity (more than four days) can delay your recovery, though people with the most severe limitations—due primarily to leg pain—may need two to four days of bed rest.
I’ve found that many patients are afraid that they will hurt their back further or delay recovery by remaining active, but the opposite is true. Staying active is one of the best things you can do to feel better more quickly. Movement helps to relieve muscle spasms and prevents loss of muscle strength, which can help you recover faster. If you find that a certain activity causes your back to hurt too much, it is fine to stop that activity and try another.
Continuing to work is usually a good thing and won’t harm your recovery. Your doctor may prescribe specific limitations on sitting, standing, walking or lifting for a period of time, but activity restrictions have no apparent benefits beyond three months.
Take preventive action
To prevent back pain from occurring or returning:
Avoid activities and postures that increase stress on the back. Minimize the stress of lifting by keeping any lifted object close to your body at the level of your navel. Also be sure to avoid twisting, bending and reaching while lifting, since these actions also increase stress on the back.
Avoid sitting for long periods of time since this may increase pain. Standing desks are a great option for many. If you must sit, however, change positions often and take brief but frequent breaks to walk around. Consider placing a soft support at the small of your back and using a chair with armrests to support some body weight. A slight recline of the chair back might also make you more comfortable.
The bottom line: Back pain at one point or another is a fact of life. However, staying active and maintaining a healthy weight will help you minimize your risks and the severity of any episodes you do have. When you do feel back pain, keep treatment simple, be patient and follow the advice outlined here. Misery doesn’t need your company.
For more information on back pain, its causes and treatment, visit the website of the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Maurice Cates, MD, is a board-certified orthopaedic surgeon with the Mid-Atlantic Permanente Medical Group in the Washington, D.C., area. He serves as the group’s Regional Director of Musculoskeletal Services. Dr. Cates sees patients in the Kaiser Permanente Frederick and Largo Medical Centers and performs hospital-based surgeries at Suburban Hospital in Bethesda, Maryland.
