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| 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.
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.
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 aswalking, swimming and yoga are popular choices.
The important thing is to choose an enjoyable activity that you can benefit from without feeling 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 orphysiotherapists (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.
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
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