Back pain - Treatment 

Treating back pain 

Back pain

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.

Pain clinics

Pain management programmes can help you to learn how to manage your pain, increase your activities and have a better quality of life. This is done with a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain. 

For more information on pain clinics in your area, visit The British Pain Society.

Compare your options

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

Vicky Joseph

'My search for a back pain cure'

Vicky Joseph spent years searching for a cure for her back pain. Find out what finally helped her.

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.

 


  • show glossary terms

 

Acute
Acute means occurring suddenly or over a short period of time.
Anti-inflammatory
Anti-inflammatory medicines reduce swelling and inflammation.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Physiotherapy
Physiotherapy is a treatment that uses physical movements, massage and exercise to relieve illness or injury.
 

Last reviewed: 14/03/2011

Next review due: 14/03/2013

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Comments are personal views. Any information they give has not been checked and may not be accurate.

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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