Treatments for back pain will vary depending on how long you've had the pain, how severe it is and your individual needs and preferences.
Short-term back pain
Most cases of back pain that last no longer than six weeks can be treated with over-the-counter painkillers and home treatments.
Painkillers
Paracetamol is effective in treating most cases of back pain. Some people find anti-inflammatory drugs such as ibuprofen more effective. A stronger painkiller such as codeine is an option and is sometimes taken in addition to paracetamol.
If you also experience muscle spasms in your back, your GP may recommend a short course of a muscle relaxant, such as diazepam.
Painkillers can have side effects, some can be addictive and others may not be suitable depending on your state of health. Your GP or a pharmacist will be able to advise you on the right type of medication to try. For more information, go to medicines for back pain.
Hot and cold treatments
Some people find that heat, for example a hot bath or a hot water bottle placed on the affected area, helps ease the pain. Others find cold, such as an ice pack or a bag of frozen vegetables applied to the painful area, is also effective. Don’t put the ice directly on your skin as it might cause a cold burn. Wrap the frozen pack in a wet cloth before applying to the affected area.
Another option is to alternate between hot and cold using ice packs and hot compression packs. Hot compression packs can be bought at most larger pharmacies.
Sleeping position
By changing your sleeping position you can take some of the strain off your back and ease the pain. If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing a pillow under your knees will help maintain the normal curve of your lower back.
Relaxation
Trying to relax is a crucial part of easing the pain as muscle tension caused by worrying about your condition can make things worse. Research suggests that people who manage to stay positive despite the pain tend to recover faster and avoid long-term back pain.
Keep moving
Most experts now agree that staying in bed, lying down or being inactive for long periods is actually bad for your back. People who remain active are likely to recover more quickly. This may be difficult at first if the pain is severe but try to move around as soon as you are able and aim to do a little more each day.
Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.
There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you to return to a normal pattern of activity, and it can often distract you from the pain.
Lifestyle
Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, having poor posture and stress.
Regular exercise and being active on a daily basis will help to keep your back strong and healthy. Walking, swimming and yoga are popular choices. The important thing is to choose an enjoyable activity that you can benefit from without feeling pain. Get tips on raising your activity levels.
Find out more about preventing back pain.
Long-term back pain
For back pain lasting more than six weeks (known as chronic back pain), your GP will advise you on what painkillers to take and recommend the following treatments:
- Exercise programme: this should involve up to eight sessions over a period of up to 12 weeks. It will usually be a group class supervised by a qualified instructor. The classes may include exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
- Manual therapy: there are different types of manual therapy, including manipulation, mobilisation and massage, usually performed by chiropractors, osteopaths or physiotherapists. If you choose a course of manual therapy, this should include up to nine sessions over a period of up to 12 weeks.
- Acupuncture, which involves inserting fine, solid needles at different points in the body, has been shown to help reduce low back pain. If you choose a course of acupuncture, this should include up to 10 sessions over a period of up to 12 weeks.
These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.
Antidepressants
If the painkillers do not help, you will probably be put on tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended for depression, but they are effective at treating some cases of persistent pain.
Some TCAs can have serious side effects, including suicidal thoughts, although this is rare. If this happens to you, contact your GP or go to your nearest hospital immediately. You may want to tell someone close to you that you are on amitriptyline and ask them to let you know if they notice any changes in your behaviour. For more information, go to medicines for back pain.
Counselling
If the treatments listed above are not effective, you may be offered some counselling to help you deal with your condition.
While the pain in your back is very real, how you think and feel about your condition can make it worse. Cognitive behavioural therapy (CBT) works by helping you to manage your back pain better by changing how you think about your condition.
Studies have shown that people who have had CBT later reported lower levels of pain. They were also more likely to remain active and take regular exercise, further reducing the severity of their symptoms.
Surgery
Surgery is usually only recommended as a treatment option when all else has failed.
One common procedure, called spinal fusion surgery, fuses the joint that is causing pain to prevent it moving.
Bone is a living tissue, which makes it possible to join two or more vertebrae together by placing an additional section of bone in the space between the vertebrae. This helps to prevent the damaged vertebrae from irritating or compressing nearby nerves, muscles and ligaments, and reduces the symptoms of pain.
However, spinal fusion is a complicated procedure and the results are not always satisfactory. You may still experience some degree of pain and loss of movement after surgery.
Other treatments
Several treatments are sometimes used to treat long-term back pain, but they are not recommended by NICE due to a lack of evidence about their effectiveness. They include:
- Low level laser therapy – low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair.
- Interferential therapy (IFT) – a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body’s natural painkillers).
- Therapeutic ultrasound – ultrasound waves are directed at your back to accelerate healing and encourage tissue repair.
- Transcutaneous electrical nerve stimulation (TENS) – a machine delivers small electrical pulses to the back through electrodes that are placed on the skin. The pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain.
- Lumbar supports – cushions, pillows and braces are used to support your spine.
- Traction – a pulling force is applied to your spine.
- Injections – painkilling medication is injected directly into your back.
