In 2017, it was estimated that 577 million people suffer from low back pain globally. This pain can limit one’s activities and quality of life. This article reviews the various treatment options for low back pain.
The majority of acute low back pain will resolve regardless of the treatment used.
NSAIDs and muscle relaxants can be used for the short-term treatment of lower back pain.
The use of acupuncture, massage, chiropractor treatment, and heat are treatment options to relieve acute low back pain.
Duloxetine and tramadol are the preferred pharmacologic treatment options when treating low back pain.
Talk with your doctor and/or pharmacist before starting any new medications.
Types of back pain
Back pain is typically classified into two main types: acute and chronic. Acute back pain will typically improve on its own and typically lasts for a few days to weeks. Chronic back pain is defined as pain that has persisted for 3 months.
The treatment of acute back pain should focus on the use of products geared to relieve inflammation and soothe aching muscles as well as non-pharmacologic options. Oftentimes, acute back pain will resolve without the use of any treatments. Chronic back pain treatment should include these measures as well but is also treated with long-term medications.
Treatment options for acute lower back pain
Acupuncture, massage, and chiropractor treatments can provide relief of the symptoms associated with acute lower back pain. These treatments have all been shown to be effective and the decision as to which one to pursue should be based on personal preference.
Heat can be applied to the lower back using either a heating pad, heat wraps (e.g.. Thermacare), or warm baths or showers. Apply the heat for 15–20 minutes at a time. Heat can also be used with ice in an alternating pattern to help relieve lower back pain.
If using a heating pad, make sure to use it with a timer to prevent an accidental burn from falling asleep and using it too long.
Over-the-counter (OTC) medications like aspirin, naproxen, and ibuprofen have not been shown to differ in pain relief from prescription NSAIDs like meloxicam, celecoxib, and diclofenac. Both prescription and OTC NSAIDs are effective in relieving lower back pain but do have side effects. It is recommended to use these agents at the lowest dose possible for the shortest amount of time to reduce the side effects.
If you have a history of stomach upset or reflux, celecoxib may be beneficial as it has fewer gastrointestinal side effects. Additionally, naproxen has a lower risk of heart complications. Therefore, it is important to discuss your options with your pharmacist or physician before starting any medication.
Skeletal muscle relaxants
Carisoprodol, cyclobenzaprine, metaxalone, methocarbamol, and tizanidine can be used for the short-term (less than a week) relief of acute low back pain. These medications are associated with dizziness and drowsiness and should be used with caution.
Treatment options for chronic lower back pain
Physical therapy is important to help improve flexibility and strength of the lower back and supporting muscles. A therapist can provide home programs to help maintain the beneficial effects of therapy.
In chronic low back pain patients, duloxetine has been reported to improve sleep, physical functioning, and pain severity. It is typically well tolerated but can have symptoms of withdrawal if stopped abruptly. Common adverse effects include diarrhea, dizziness, dry mouth, fatigue, headaches, insomnia, and nausea.
The use of tramadol for the short-term relief of back pain has been supported in studies. It has also been shown to improve the functional status of patients. Studies have also shown it to be more effective when used with acetaminophen (Tylenol). However, it does have addictive properties and should be used only under the guidance of a physician.
The treatment of acute low back pain is focused on providing pain relief and improving functional status. There are many modalities to choose from but the majority of acute back pain will resolve on its own. Chronic low back pain is difficult to manage and thus requires various modalities that are safe to use for an extended period of time.