Treatment for Acute Low Back Pain
For treating short-term acute low back pain, the best results derive from the least aggressive treatments. The general approach is the following:
- Patients with no indication of any serious underlying cause should stay as active as possible within the limits of the back pain. (Bed rest is not recommended.) Some studies suggest that a third of patients with uncomplicated low back pain are significantly improved after a week with no other treatment than normal activity and two thirds have recovered by seven weeks.
- Physical therapy or spinal manipulations may be helpful if pain continues for more than two to three weeks.
- The patients should seek a specialist if pain continues for more than a month (or less than this if there are indications of an underlying disorder, nerve damage, or injury).
Back pain attributed to medical conditions, such as arthritis, osteoporosis, or pregnancy, either resolves when the condition does or is treated as part of the overall therapeutic plan.
Immediate Treatment of Acute Low Back Pain of Unknown Cause
Experts now recommend that people with acute low back pain attempt to resume normal activities as soon as possible. They should be conducted without strain or stretching. Simply letting pain be the guide is the best approach for achieving movement. In general, normal activity should be resumed in a gradual fashion as soon as the patient feels ready, reserving therapeutic exercises until after the acute pain has resolved.
Specific Tips for Relieving Pain. At the onset of acute low back pain when the cause is unknown, the following tips may be helpful:
- Bed rest is no longer recommended and may delay recovery. Patients should remain active, but should let the pain guide his or her behavior and should probably stop normal physical activities for the first couple of days in order to calm symptoms.
- Over-the-counter pain relievers, usually the nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil and others) often provide significant benefits. Muscle relaxants may be helpful in some patients, although their benefits are uncertain. Once started, medications should be taken on a regular schedule in order to maintain consistent effectiveness.
- Application of heat (104 degrees for eight hours a day) can be very helpful. In one study it was more effective than ibuprofen (Advil and other brands) or acetaminophen (Tylenol and other brands) for nonspecific low back pain. Many people find that alternating ice packs and heating pads is helpful in relieving the pain. Some people recommend changing from hot to cold every three minutes and repeating this sequence three times. (Some experts believe ice packs should be applied first.) This regimen should be performed two or three times during the day. (Heat or cold treatments do not have much effect on sciatica.)
- Supportive back belts, braces, or corsets may help some people temporarily, but they can reduce muscle tone over time and should be used only briefly.
- Healthy sleep plays a vital role in recovery. It is often difficult to get a good night's sleep when suffering from back pain, particularly because the pain can intensify at night. Take a warm bath before bedtime, and practice relaxation techniques. It may be necessary to take medication to help manage nighttime pain or treat sleeplessness. To help promote sleep, avoid caffeine in the afternoon and evening. Lying curled up in a fetal position with a pillow between the knees or lying on the back with a pillow under the knees may help.
- Massage therapy may be helpful for many people with both acute and chronic low back pain. In fact, three well-conducted studies demonstrate some benefit and suggest it may reduce the costs of care. However, it is usually not covered by insurance.
- Spinal manipulation may be helpful, although it is not clear if it is any more helpful than physical therapy or general care. Some experts recommend delaying this treatment until pain has persisted for three weeks, if possible, since the back pain will most likely have resolved on its own by then.
Treatments That Provide No Benefits
Patients should be aware of and avoid certain approaches that are not helpful and, in some cases, may be harmful for acute low back pain:
- Bed rest. Bed rest for low back pain, including most cases of sciatica, is no more effective and may even be worse than simply continuing normal activities to the degree possible. Long-term bed rest results in loss of muscle tone and bone strength, increases susceptibility to blood clots, and causes depression and lethargy.
- Exercise in the acute phases of low back pain. Intense exercise and physical activity should be avoided during acute back pain, particularly heavy lifting and trunk twisting. (Specific exercises can be important during recovery, however, as well as for patients with chronic low back pain.)
- Acupuncture. Acupuncture has not proven to have any value for acute low back pain in most patients, but may provide some help for patients with chronic low back pain.
- Magnet therapy. Permanent bipolar magnets have gained some popularity as a non-invasive method of relieving pain. To date no studies support such claims and one 2000 study reported no effect in alleviating low back pain. It should be noted that magnets can deactivate heart devices and must be kept at least six inches away from pacemakers or implantable cardioverter defibrillators.
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