From the Guidelines
The best first-line treatment for back pain is nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation, and if pharmacologic treatment is desired, nonsteroidal anti-inflammatory drugs (NSAIDs) should be selected as the first-line option. According to the most recent and highest quality study 1, patients with acute or subacute low back pain can benefit from nonpharmacologic treatments, and if medication is needed, NSAIDs are recommended due to their effectiveness in pain relief.
Some key points to consider when treating back pain include:
- Starting with nonpharmacologic treatments such as exercise, multidisciplinary rehabilitation, acupuncture, or spinal manipulation 1
- Using NSAIDs as the first-line pharmacologic treatment, considering their benefits and risks, and selecting the lowest effective dose for the shortest period necessary 1
- Avoiding bed rest beyond a day or two, as prolonged inactivity can worsen pain
- Applying ice or heat to the affected area for 15-20 minutes at a time, several times a day
- Gentle stretching and low-impact exercises like walking can help maintain flexibility and strength
It's essential to weigh the potential benefits and harms of any treatment, especially when considering pharmacologic options like NSAIDs or opioids, and to carefully assess cardiovascular and gastrointestinal risk factors before prescribing these medications 1. By prioritizing nonpharmacologic treatments and using pharmacologic options judiciously, patients with back pain can experience improved outcomes and reduced risk of adverse events.
From the Research
Treatment Options for Back Pain
- The best first-line treatment for back pain is a topic of ongoing research and debate, with various studies suggesting different approaches 2, 3, 4, 5, 6.
- Non-pharmacological treatments, such as lifestyle changes, physiotherapy, and non-pharmacological methods, have been shown to be effective in managing chronic low back pain 2.
- A multidisciplinary biopsychosocial rehabilitation program, including exercise, has been found to be effective in improving mobility, strength, and return-to-work rates 3.
- Behavioral therapy approaches, such as cognitive behavioral therapy and mindfulness-based stress reduction, can also be used to manage low back pain 4.
- Conservative management of low back pain may include patient education, therapeutic exercises, and bracing 5.
- Spinal manipulative therapy (SMT) has been found to be effective in managing acute and chronic low back pain, and can be used in combination with other conservative treatments 6.
Key Findings
- A study published in 2017 found that non-pharmacological methods, such as massages, heat application, and acupuncture, were perceived as effective by patients with chronic low back pain 2.
- A narrative review published in 2024 found that conservative treatment of chronic low back pain should start with reassurance and clear patient education, and may include additional treatments such as manipulation, massage, and acupuncture 3.
- A systematic review published in 2018 found that behavioral therapy approaches, such as electromyography biofeedback and cognitive behavioral therapy, can be used to manage low back pain 4.
- A review published in 2021 found that conservative management of low back pain should include recognizing prognostic factors, initial approaches to evaluation, and conservative management including patient education and therapeutic exercises 5.
- A guideline published in 2018 by the Canadian Chiropractic Guideline Initiative found that SMT can be used to manage acute and chronic low back pain, and can be used in combination with other conservative treatments 6.