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Nonsurgical AlternativesAbout one out of three people with back pain will improve substantially in a week, and two out of three will feel better after seven weeks. So a wait-and-watch approach plus some simple pain-management strategies are the best course for most people, Haig says.
But that doesn't mean taking to your bed, he adds. In spite of the once-prevailing belief that bed rest is the best therapy for an aching back, doctors now advise just the opposite. "When people are confined to bed, they lose muscle mass, coordination, and balance," Haig says. "For every week you spend in bed, you need six to eight weeks to regain lost muscle and get yourself back in shape." If you feel you must rest, don't stay in bed for more than a couple of days and even then try to get up periodically and move around.
To reduce inflammation and pain, apply an ice pack for 20 to 30 minutes several times a day for the first day or two. After that, a heating pad set on low may offer some relief. Over-the-counter pain relievers such as acetaminophen, aspirin, or ibuprofen can also help.
If you don't feel any improvement after a month, see your doctor or seek help from a center that specializes in treating back pain. These programs combine the techniques of several specialists. In many of them, a physiatrist (a physician who specializes in rehabilitation medicine) or other expert, such as an osteopath (whose training emphasizes musculoskeletal disorders), works with a physical therapist to develop an exercise regime that will stretch and strengthen the muscles and ligaments of the back and other parts of the body.
In some cases doctors recommend antidepressants, even if the person isn't depressed. "Antidepressants seem to regulate the brain's neurotransmitters that control sensory perceptions," Haig explains.
Anti-seizure medications may also relieve pain. "We don't know exactly why," Haig continues, "but when back pain becomes chronic, it cycles like a reverberating circuit in your brain, sending signals that say, 'I hurt, I hurt.' An anti-seizure drug may interrupt that cycle."
But, he cautions, these and other drugs have side effects. "People need to understand that they have a choice to use or not use medicine for pain," he says. "No medicine cures all back pain. You and your doctor have to make a judgment based on the cost and side effects of a drug versus the amount of pain you're in."
If you have pain, especially from sciatica, that's so severe it keeps you from exercising, you may benefit from an epidural cortisone injection, Haig says. "These have been used for 15 or 20 years to reduce the inflammation and swelling around nerve roots, but until recently, doctors weren't able to inject the cortisone in exactly the right place. Today, however, some doctors use fluoroscopes to locate the site of the inflammation, so the injections are more accurate." Although no research shows that these epidural cortisone injections cure back pain, and relief lasts only two or three months, that may be enough time to begin an exercise program and start benefiting from it.
What Doesn't Work
Some common treatments for back pain either don't work at all or provide minimal relief at best. Traction, for example, has been shown to be ineffective. And a recent large-scale study found that back braces and support belts (items often sold through mail-order health products catalogs and magazine ads) not only do not relieve pain or prevent injury but may actually increase the risk of damage. These devices tend to give their wearers a false sense of security, making them more likely to move incorrectly and put undue strain on their backs.
Transcutaneous electrical nerve stimulation (TENS), a mild application of electrical current to the skin over the painful area, which attempts to block pain signals traveling to the brain, has also proved ineffective. On the other hand, a related procedure, percutaneous electrical nerve stimulation (PENS), in which acupuncture needles are used to deliver electricity, may offer some relief, according to preliminary research. Traditional acupuncture may relieve pain over the short term, but there's no evidence that the improvement lasts, according to Haig. The same goes for massage therapy. "We need careful research on both procedures," he says. "So far, the jury's still out."
As for magnet therapy? "It's a complete scam," Loeser says. "Don't waste your money."
Preventing Pain
To reduce your risk of developing back pain or to prevent a recurrence, "Stay strong, flexible, and coordinated," Haig says. That means committing yourself to a program of stretching, aerobics, and strength training.
Also, if you still smoke, quit. "Research shows that cigarette smoking is a significant risk factor for back pain," Haig notes.
The way you sit or the mattress you sleep on may play some role in back pain, but not for reasons you might imagine. "There's no 'right' way to sit," Haig says. "What's important is that you are able to move around in your chair, to flex your back, and stretch your legs." An ideal chair has arms, provides support for your back (a lumbar cushion can be useful), and isn't so high that your legs dangle.
While folklore holds that a hard mattress is better for a bad back, you can sleep on whatever kind of mattress feels best, Haig says. It's a matter of individual choice. One may like to sleep on their side with a pillow between her knees or on her back with a pillow under her knees. Pillows work for some but not for others.
Ultimately, preventing back pain means staying active and exercising. And if you suffer from back pain, don't look to the experts for a quick fix. "Over the years, we've found that one of the major problems is that people with back pain have been misled into thinking that they can get rid of their symptoms if they find a smarter, better doctor," Loeser says. "But the truth is that they need to make themselves better."
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