Millions of people live with lower back pain, either for a short or long time – 60% of UK adults will get it at some point. But knowing what to do to try to relieve the symptoms can be difficult. And a new global review of the evidence is negative about most of the available treatments.
However, there are a number of treatments that medical bodies, such as the National Institute for Health and Care Excellence (Nice) and the NHS, say do relieve pain.
Exercise
Exercise in all its forms, such as stretching, strengthening, aerobic workouts and yoga, are all useful as the first step in managing lower back pain, Nice says. NHS England agrees. It advises to “try doing some exercises and stretches for back pain”.
The authors of the global review, published in BMJ Evidence-Based Medicine, also say the evidence they examined shows exercise is one of five ways of tackling chronic lower back pain that are effective.
And the Chartered Society of Physiotherapists adds: “Exercise has been shown to be the most helpful treatment for back pain. Hands-on treatments have been shown to have a small benefit to back pain, but only when used as part of a whole treatment programme, which includes exercise.”
Nice and the NHS both recommend that sufferers continue with their normal activities as far as possible.
Medication
Drugs work for some people, but it has to be the right one. Paracetamol used to be the medication that people with back pain were advised to take.
But these days, people should take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, according to Nice. NHS England says: “Take anti-inflammatory medicine like ibuprofen. Paracetamol on its own is not recommended for back pain but it may be used with another painkiller.”
NSAIDs are the one treatment of the 56 examined that the authors of the new global study concluded helps tackle acute lower back pain. Nice also say: “Weak opioids, such as codeine, are only recommended for acute back pain when NSAIDs haven’t worked or aren’t suitable.”
Physiotherapy
Family doctors refer many patients with lower back pain to a physiotherapist, to have their condition assessed and be given exercises, said Prof Kamila Hawthorne, the chair of the Royal College of General Practitioners.
But others, whose pain is more chronic, instead see a link worker who suggests non-medical interventions. “Many patients do report feeling some relief from the interventions – medical or not – that we suggest,” the review said.
However, Nice says that “massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone”.
Psychological or talking therapy:
Nice recommends a combination of physical and psychological treatments, or “talking therapies” – often cognitive behaviour therapy – for people who have not seen their pain improve using other treatments, “or who have significant psychological and social barriers to recovery”.
Heat and cold:
“Use an ice pack, or bag of frozen peas, wrapped in a tea towel to reduce pain and swelling,” NHS England recommends. It also advises people to “use a heat pack, or hot-water bottle, wrapped in a tea towel to relieve joint stiffness or muscle spasms”.
