Low Back Pain Treatments: Non-Surgical

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Typical non-surgical treatment options for low back pain include:

Pain medications

There are multiple over-the-counter (non-prescription) and prescription medications that can be helpful in relieving pain and addressing related symptoms while an episode of low back pain is getting better. Careful attention to pain management is a critical component of a patient’s recovery, as acute or chronic low back pain can lead to depression, difficulty sleeping, and difficulty exercising and stretching, all of which in turn can exacerbate and prolong a painful back condition.

Two types of over-the-counter medications, acetaminophen and non-steroidal anti-inflammatory drugs (NSAID’s), are commonly recommended to alleviate low back pain. For short periods of time, prescription medications (such as narcotic pain medications and muscle relaxants) may be helpful to alleviate pain or related complications. Other classes of drugs (such as antidepressants or anti-seizure medications) can also help modulate the sensation of pain and can be taken on a prolonged basis.

There are risks, side effects and drug interactions with any medication, so a medical professional should always be consulted prior to taking medications.

Physical Therapy

After an episode of low back pain has lasted between two and six weeks, or if there are frequent recurrences of low back pain, it is reasonable to consider back pain exercises and physical therapy for treatment. (Some spine specialists consider back exercise and physical therapy sooner, particularly if the pain is severe.) In general, the goals of back pain exercises and physical therapy are to decrease back pain, increase function, and provide education on a maintenance program to prevent further recurrences.

Manual Manipulation

Chiropractic and osteopathic medicine represent another conservative treatment option for patients with low back pain. The overall philosophy for chiropractic and osteopathic manipulations is that joint dysfunction in the lower (lumbar) spine can produce low back pain. Mobilizing the lumbar spine joints though manipulations (commonly referred to as "adjustments") can decrease low back pain.

Chiropractic or osteopathic manipulations can be especially helpful in relieving pain for facet joint injuries, osteoarthritis, and sacroiliac joint dysfunction, as these conditions represent joint dysfunction that responds well to mobilization.

Injections

Spinal injections may considered as an option to treat low back pain after a course of medications and/or physical therapy is completed, but before surgery is considered. Injections can be useful both for providing pain relief and as a diagnostic tool to help identify the source of the patient’s back pain. By far the most common injection is an epidural steroid injection.

For pain relief, injections can be more effective than an oral medication because they deliver medication directly to the anatomic location that is generating the pain. Typically, a steroid medication is injected to deliver a powerful anti-inflammatory solution directly to the area that is the source of pain.

Diagnostically, injections can be used to help determine which structure in the back is generating pain. If lidocaine or similar numbing medication is used, and the patient feels temporary relief after an anatomic region is injected (e.g. facet joint or sacroiliac joint), it can then be inferred that the specific region is the source of the pain.

Physical therapy and exercise, along with back care education, are most often recommended. Many patients with back problems believe that they should avoid all exercise in an effort to protect the back from pain or further injury. Inactivity and lack of exercise can actually worsen existing problems and contribute to future pain. A combination of improved everyday posture, ergonomics, and regular stretching and exercise all play an important role in good back care.

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