Back pain - Treatment 

Treating back pain 

Back pain (BSL version)

Back pain is the largest cause of absence from work in the UK. Philip Sell, consultant orthopaedic and spinal surgeon, discusses the causes of and treatments for back pain.

Media last reviewed: 30/09/2013

Next review due: 30/09/2015

Pain clinics

If you have long-term (chronic) pain, you may be able to attend a specialist pain clinic.

Pain clinics help people manage their pain and provide advice about things such as increasing your activity level and how to have a better quality of life despite being in pain.

Your programme may involve using a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain. 

The British Pain Society website has more information about pain clinics in your area.

Pain: keep active

If you're in pain, keeping active will help as stiffening up can make pain worse.

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for back pain

Treatments for back pain will vary depending on how long you have 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 non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, more effective. A stronger painkiller, such as codeine, is also 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 give you advice about the most appropriate type of medication for you.

Read more about the 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.

Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area is also effective. Do not put the ice directly on to your skin because it might cause a cold burn. Wrap the frozen pack in a wet cloth before applying it to the affected area.

Another option is to alternate between hot and cold using ice packs and hot compression packs or a hot water bottle. Hot compression packs can be bought at most larger pharmacies.

Sleeping position

Changing your sleeping position 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 because 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 quicker and avoid long-term back pain.

Read more about relaxation tips to relieve stress.

Keep moving

Most experts now agree that staying in bed, lying down or being inactive for long periods is 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 can 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 return to a normal pattern of activity, and it can often distract you from the pain.

Exercise and lifestyle

Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress.

Regular exercise and being active on a daily basis will help keep your back strong and healthy. Activities such as walkingswimming and yoga are popular choices.

The important thing is to choose an enjoyable activity that you can benefit from without feeling pain.

Read more about preventing back pain.

Long-term back pain

If you have had back pain for more than six weeks (known as chronic back pain), your GP will advise you about which painkillers to take and recommend the treatments listed below.

  • Exercise - usually take the form of 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. NICE recommend a maximum of eight sessions over a period of up to 12 weeks.
  • Manual therapy - there are different types of manual therapy including manipulation, mobilisation and massage, usually carried out by chiropractors, osteopaths or physiotherapists (chiropractic and osteopathy aren't widely available on the NHS). NICE recommend a maximum of nine sessions over a period of up to 12 weeks.
  • Alexander technique - teaches you how to eliminate unnecessary muscular tension from your body. It aims to make you aware of any bad postural habits that you have while sitting or standing, as well as any inefficiencies in the way you move. You'll learn how to improve the balance and alignment of your body.
  • Acupuncture - an ancient Chinese treatment where fine needles are inserted at different points in the body. It's been shown to help reduce lower back pain. NICE recommend that an acupuncture course should include a maximum of 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.

Nerve root blocks

A nerve root block is where a steroid or anaesthetic is injected into your back. If your back pain is caused by a trapped or inflamed nerve in your spinal column, the injection can help relieve the pain in your back, plus any associated leg pain.

To be effective, the injection needs to be made at exactly the right place in your back, so the procedure will be carried out under X-ray or CT guidance.

Facet joint injections

It is also possible to have anaesthetic or steroid injections in the facet joints. The facet joints are the joints that connect one vertebrae to another so that your spine is kept aligned. The joints are sometimes affected by arthritis. Facet joint injections are not always effective at relieving back pain.

Antidepressants

If the painkillers do not help, you will probably be prescribed tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended to treat depression, but they are also effective at treating some cases of persistent pain.

If you are prescribed a TCA to treat persistent back pain, the dose is likely to be very small.  See medicines for back pain for more information.

Counselling

If the treatments described above are not effective, you may be offered 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 for back pain is usually only recommended when all other treatment options have failed.

Surgery may be recommended if your back pain is so severe or persistent that you are unable to sleep or carry out your day-to-day activities. The type of surgery will depend on the type of back pain you have and its cause.

For example, a procedure known as a discectomy may be used if you have a prolapsed disc. The discs are the circular, spongy tissue between the vertebrae that help cushion your spine. A prolapsed disc is where the hard outer membrane of the disc is damaged, causing the soft, jelly-like fluid inside to leak out.

A discectomy involves removing the damaged part of the disc through an incision made in your back. It is now possible for surgeons to carry out the procedure using a very small incision and a microscope or magnifying lenses to find the damaged disc. This minimizes the amount of trauma to the surrounding tissue, reduces the pain and discomfort in the affected area and results in a smaller scar.

Spinal fusion surgery is a less common surgical procedure where the joint that is causing pain is fused to prevent it moving.

As bone is living tissue, it is possible to join two or more vertebrae together by placing an additional section of bone in the space between them. This prevents the damaged vertebrae irritating or compressing nearby nerves, muscles and ligaments, and reduces the symptoms of pain.

Spinal fusion is a complicated procedure and the results are not always satisfactory. For example, you may still experience some degree of pain and loss of movement following surgery.

Before you agree to have surgery to treat back pain, you should fully discuss the risks and benefits of the procedure being recommended with your surgeon.

Other treatments

A number of other treatments are sometimes used to treat long-term back pain. However, they are not recommended by the National Institute for Health and Care Excellence (NICE) due to a lack of evidence about their effectiveness. They include:

  • low level laser therapy – where low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair
  • interferential therapy (IFT) – where 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 – where ultrasound waves are directed at your back to accelerate healing and encourage tissue repair
  • transcutaneous electrical nerve stimulation (TENS) – where a TENS machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) that are attached to your skin; the pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain
  • lumbar supports – where cushions, pillows and braces are used to support your spine
  • traction – where a pulling force is applied to your spine
  • injections – where painkilling medication is injected directly into your back

 


Page last reviewed: 21/02/2013

Next review due: 21/02/2015

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The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Kazbee said on 01 October 2014

I have suffered with back pain now for over 20years and sometimes it's unbearable, I have had lots of treatments including injections which were very painful and unreflective, I've had lots of treatments, I was sent to pain management programme which helped me meet people in similar situations and I also found out I have fibromyalgia , both forms of arthritis, and spondylitis, I couldn't believe that I had suffered with all this for years and had been constantly told I had either water infections or general aches and pains and was given lots of antibiotics and various concoctions from my doctors surgery, I now suffer with depression due to all the pain some days are ok and some are awful but I pray that my children don't inherit this and that someone will come up with some sort of pain relief that works, it took me breaking down and crying to actually get diagnosed if thee is anything out there that works let me know. Please.

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ASmithy said on 29 September 2014

Why are they recommending paracetamol when it's been proven to have no effect on back pain? NSAIDs are also a last resort for me as they have bern shown to cause arthritis.

I use the osteomat, which works like acupuncture but without the voodoo of Chinese Meridean Theory. It's not a cure, but it helps.

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ellie_may10 said on 04 May 2013

i injured my back 3 years ago by falling on it and in the last year it has become increasingly worse. I do lot of dancing/ cheerleading so im flexible and am constantly lifting people. I dont know whether catching people and flexibility is straining my muscles. Can anyone offer some advise please?

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Sirwellingtonboot said on 14 April 2013

As usual with the NHS the first remedy mentioned is the pharmaceutical products. It is generally accepted that painkillers provide only temporary relief and only mask the problem in the long term.
There is very little mention of the benefits of stretching for back pain. I suffer with back pain which is related to my occupation. Having gone through various channels to solve this ( the NHS being the least effective, and the others being extortionately expensive) the most effective remedy I found was simply stretching my thigh muscles (quadriceps).
The quad stretch was almost instantly effective.

I now regularly stretch my legs and hips which provides the most effective and cheapest control for managing any back pain.
If the NHS could have provided this information from the outset it would have saved me a lot of time and money and unnecessary pain.

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Ladywriterwriter said on 10 July 2012

continued. there was people in wheelchairs at yoga classes and severely disabled people and I thought, if they can do this, then so can I.they were in pain yet they were doing the exercises.

Then I started to go swimming as well to work my muscles, I limped to the pool side in agony, but when was in the pool swimming it didnt hurt so much, I could swim better then I could walk.

As time went on it started to ease, I joined weight watchers at that time and lost 2 stones. Ok will be honest, I ended up putting that back on later when got thyroid disease so harder to shift weight now.

I now go swim and gym and do walking etc. It all helps. and endorphins all work and help.

Long term back pain will always be there. Some days I am fine and then all of a sudden I will get an attack of it which can last few days, or a month and I am stiff again. But I think my body had learned to deal with it now.

All we can do is our best really.

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Ladywriterwriter said on 10 July 2012

My back pain begun in 1999. As it got worse I was crippled up in agony for months. My life was a misery, I had to walk up and down stairs in the house then on my bum. I had sciatica pains up and down legs to and constant pins and needles in my feet to. I ended up sleeping on the floor as was less painful then in a bed at that time. I saw this doctor, that doctor, had scans at hospital. Then stated the name degenerated disease of lower spine, basically meaning wear and tear over the years of ageing. the 2nd disk from bottom the cushion grissle between is thinning down. I was told the worst by a hospital before I had the positive, You may end up not being able to to walk, your bowels may not be controllable any more. when I came out I was totally depressed and at the time in my 30's.

Then I saw my own doctor GP then and he gave me some useful advice which helped me so much of which all the consultants and specials could not offer.

He advised me to take short walks, to strengthen up my back muscles so they could then give support to the spine and to lose a bit of weight to. He said to me,at first you will be in agony doing this as of course it will hurt, but if you have the will power to break thru the pain barrier of this then the worst is over the the pain will ease. And he was right.

I nearly died a thousand times even walking around the block in agony. But each day I walked a little further and as time went on the pain started to ease, as my body was getting the exercise it lacked. By sitting in agony for hours my muscles were not working and sitting there like lumps sleeping. So then when I tried to move it killed me.

He told me not to sit for longer then 20mins at a time as my back would seize again. I could not work then as I was simply in to much pain. I crawled along the floor like a dog at one point. Its like a kind of self rehabilitation.

Then I joined a yoga class as yoga is very slow movements of which I could cope with, continued

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agass said on 27 May 2012

I have a lower back pain for over 3 months. ive seen my GP and ive been told is common disease for the job i do. (im a full time waitress standing on my legs around 10 hrs/day).
ive been sugested to take painkillers and exercize every day for 15 mins.

well i've doing this since ive seen my GP and kept working but bit less. My spine still hurts, even more. And now pain appeard in my legs too.

Ive decided to see a private doctor from country i come from. ive been suggested to take a month off and focus on proper rehabilitation.

My question is: how i can get rehabilitaion in England with NHS? i cant afford to do it in private. and should i keep working or ill get a letter form my GP to present at my workplace?

Not sure what to do, as i live in England for couple of years, and never used NHS for something like this.

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Caspar said on 11 April 2011

BBC medical programme – looking for sufferers of chronic back pain & osteoarthritis

Oxford Scientific Films is making a pilot medical programme for the BBC. The show aims to help the British public become healthier and better manage common illnesses such as back pain.

The programme is presented by two experts, one a medical doctor, the other a science professor, who share a private practice together in Harley St. During the programme our experts will examine and treat three patients, and explain the science behind the condition and treatment.

We are looking for people with chronic back pain or osteoarthritis who may be interested in appearing in the pilot. Our experts would offer them a bespoke personalized treatment programme lasting up to six weeks, and we would follow the course of their treatment in the programme.

If you are interested in taking part in the programme please contact Davina Bristow at dbristow@oxfordscientificfilms.tv or on 0207 317 1359.

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User137970 said on 14 January 2011

I was disappointed when looking at the section on acupuncture and back pain that the Acupuncture Association of Chartered Physiotherapists was not listed. This organisation represents Chartered Physiotherapists who have undertaken extra training in Acupuncture. Chartered Physiotherapist are regulated by the Health Profession Council so are therefore state registered and regulated. Several of my colleagues alreadly offer acupuncture within the NHS for people with Back pain.
I work as a Clinical Specialist Physiotherapist in a Pain Clinic in Cornwall. Our team has been offering acupuncture for the past twenty years.
In addition to this Physiotherapist are well placed to offer a combination of manual therapy, advice on exercises and self-help strategies. All of which are recommended in the NICE guidance.

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claymorejohn said on 20 September 2010

i have suffered for some years now, i'm on paracetamol, and morphine slo release tablets, with all the other bits and bobs that are painful i consume 23 different pills a day just to get around, i have broken my back twice, ankles (both) had a triple by-pass that failed, i have a back brace, ankle braces, knee brace as all my joints are affected with arthritis and muscles with fibro mialga, i have m.e. diabetes, austioparosis in lower back, i still manage to walk some but always in great pain, my head feels so heavy i can hardly keep it upright, i would like a neck brace with a headrest, just so i can have 40 winks on a walk, anyone have a spare?/?

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