If lower back pain frustrates you, there’s an unfortunate reality: only a small fraction of noninvasive treatments are truly effective. A comprehensive review of numerous studies analyzed over 300 clinical trials on various treatments to determine their effectiveness in reducing low back pain intensity.
For acute low back pain, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, diclofenac, or naproxen provide some relief. For chronic back pain lasting 12 weeks or longer, the most effective treatments include exercise, spinal manipulative therapy, taping, antidepressant medication, and capsaicin patches. However, these treatments only reduced pain by four to eight points on a 100-point scale, indicating modest benefits.
Some commonly used treatments were found to be ineffective. For acute low back pain, exercise, cortisone injections, and acetaminophen did not show significant relief. In cases of chronic back pain, antibiotics and anesthetics such as lidocaine were also ineffective. The effectiveness of other treatments remains uncertain due to inconclusive evidence.
Back pain is one of the leading causes of disability worldwide, affecting hundreds of millions of people. The challenge in treating it effectively lies in the multiple factors that contribute to its persistence. If treatment does not address the underlying cause, the pain may continue or return.
Back pain is categorized as either specific or nonspecific. Specific back pain has a known cause, such as a spinal fracture or a narrowing of the spinal canal. However, the vast majority of cases between 85% and 95% are nonspecific, meaning no single cause can be pinpointed. Consulting with a healthcare provider is crucial to determining the type of back pain and finding appropriate treatment options.
A good starting point for managing nonspecific low back pain includes a short course of NSAIDs, discussions with a healthcare provider about the typical progression of back pain, and a plan for gradually resuming movement, work, and social activities. However, NSAIDs should be used with caution, particularly for individuals with certain health conditions, such as a history of gastrointestinal bleeding or heart disease.
When pain persists for weeks or months, a different approach may be needed. Anti-inflammatory medications can mask symptoms, but they do not address the root cause. Identifying and treating the cause of pain is essential for long-term relief. Dysfunction in the sacroiliac joints, which connect the spine to the pelvis, is a common issue among those with back pain. Prolonged sitting can exacerbate discomfort in these joints, and targeted exercises may help realign them, as shown in some preliminary research.
For individuals who do not find relief through conservative treatments, interventional therapies may be considered. These more invasive options include procedures such as radiofrequency ablation to disrupt nerve signals, implantable spinal cord stimulators, or surgery to correct anatomical problems.
Studies have shown that medical management alone does not provide long-term relief for most individuals, with only a small percentage of patients experiencing significant pain reduction and functional improvement. In many cases, a combination of treatments tailored to the patient’s specific condition offers the best outcomes.
Imaging tests, such as magnetic resonance imaging (MRI), can help guide treatment decisions by identifying structural issues like degenerative disk disease or nerve compression. For example, a person with degenerative disk disease, loss of function, weight gain, and a history of psychological trauma may benefit from a combination of physical therapy, counseling, and interventional treatments targeting the affected disks.
Effective back pain management requires a personalized approach. By assessing various factors and combining appropriate therapies, individuals can achieve better pain relief and improved function, leading to a better quality of life.
