Non-Surgical Treatments for Lower Back Pain

The goals of treating lower back pain are usually to both reduce pain and to improve one’s ability to function and engage in activities of daily living.

For acute flareups of pain, a short period or rest or reduced activity may be recommended, but prolonged rest is usually counterproductive.

To address the underlying cause of pain, some type of therapy that creates a better healing environment and actively rehabilitates the spine will almost always be prescribed alongside pain-relieving treatments.

Common Medical Treatments for Pain Relief

The most common medical treatments for lower back pain include:

Muscle relaxants

This medication acts as a depressant of the central nervous system and increases mobility of tense muscles, relieving pain caused by muscle spasm and tightness. Muscle relaxants are used for acute pain, and have no role in chronic pain management.

Narcotic pain medications

Narcotic medications, also called opioids or painkillers, alter the brain’s ability to perceive pain by weakening the pain signals. Narcotic medications are most often prescribed only for intense, short-term pain, such as acute pain after an operation. Narcotics are not usually recommended for long-term pain, as they have significant adverse side effects and can easily become addictive.

See Opioid Medication Potential Risks and Complications

Back braces

Some patients find that a lower back brace provides stability that in turn reduces pain. There is some evidence that use of an inelastic corset-style brace, worn daily, in combination with a physical therapy exercise program, can speed healing and reduce pain.¹Morrisette D, Cholewicki J, Logan S, Seif G, McGowan S. A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of low back pain. Spine (Phila Pa 1976). 2014 October 1; 39(21):1733-42

A back brace may also be used to provide stability for the lower back while healing from back surgery.

Injections

The goal of most injections is to provide enough immediate pain relief to allow active participation in physical therapy.  Injections are also commonly used to confirm a diagnosis of the cause of pain. Examples of common injections include a lumbar epidural steroid injection, facet joint injection, medial branch nerve block, and selective nerve block.

Ablation

This type of procedure does not inject medication into the spine; rather, a probe is inserted into the spine to destroy a nerve by heating it, thereby eliminating the pain signals. Examples of common ablation techniques include radiofrequency ablation (RFA) for facet joint pain, and basivertebral nerve ablation (BVN) for vertebrogenic back pain.

Manual manipulation

Manual spinal manipulation involves making physical adjustments to the spine with the goals of improving mobility and reducing stiffness, discomfort, or pain. Hand thrusts to adjust the spinal structures can be done with low velocity or high velocity, depending on the patient’s condition and preferences. Manual manipulation has been found to relieve low back pain in some people.²Furlan A, Tazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. Evidence Report/Technology Assessment No. 194. AHRQ Publication No. 10(11) E007. Rockville, MD; Agency for Healthcare Research and Quality. October 2010. Accessed July 13, 2016.

Acupuncture

The approach in acupuncture is to stimulate points on the body using ultra-fine needs needles placed in specific areas of the skin. Acupuncture has been shown to provide significant pain relief for some people.²Furlan A, Tazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. Evidence Report/Technology Assessment No. 194. AHRQ Publication No. 10(11) E007. Rockville, MD; Agency for Healthcare Research and Quality. October 2010. Accessed July 13, 2016.

Massage therapy

When applied to the low back, massage therapy can relieve the muscle spasms that usually contribute to low back pain. Massage also increases blood flow to the low back, which speeds up healing by bringing nutrients and oxygen to damaged muscles.

Mindful meditation

Meditation tends to be helpful in reducing the perception of pain, and can also reduce depression, anxiety and sleep problems that commonly occur with chronic pain. Meditative techniques for pain reduction include everything from deep breathing exercises to an altered focus approach.

The above is not a comprehensive list; there are many more treatment choices available, including newer and less invasive surgical options.