What are the resources for managing lower back pain?

From the Guidelines

For managing low back pain, I recommend a multi-faceted approach starting with non-medication strategies, prioritizing nonpharmacologic therapies with proven benefits, such as spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, as supported by the most recent and highest quality study 1.

Key Recommendations

• Stay active with gentle exercises like walking and swimming, and apply heat or cold packs for 15-20 minutes several times daily.
• Consider nonpharmacologic therapies, such as spinal manipulation, which is associated with small to moderate short-term benefits for acute low back pain 1.
• For subacute or chronic low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation may be beneficial, with small to moderate, usually short-term effects on pain 1.
• Proper body mechanics are crucial—bend at the knees when lifting, maintain good posture, and use ergonomic furniture.

Medication Use

• Over-the-counter medications like acetaminophen or NSAIDs, such as ibuprofen, can help manage pain, but their use should be limited to the shortest duration necessary, as the evidence for their long-term benefits is limited 1.
• Systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, as they have not been shown to be more effective than placebo 1.

When to Seek Medical Attention

• If pain is severe or persists beyond 4-6 weeks, or if you experience warning signs like numbness, weakness, or bowel/bladder changes, consult a healthcare provider promptly.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Management of Low Back Pain

• The American College of Physicians (ACP) recommends nonpharmacologic treatments as first-line therapy for acute, subacute, and chronic low back pain 2.
• Primary care providers typically provide advice to stay active and pharmacologic management for acute low back pain, while nonpharmacologic treatments are more likely to be recommended for chronic low back pain 2.
• Common nonpharmacologic treatments for chronic low back pain include physical therapy, chiropractic care, massage therapy, and acupuncture 2, 3, 4.

Pharmacological Treatments

• First-line pharmacologic agents for acute low back pain include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), while muscle relaxants can be used for spasms and pain reduction 5, 6.
• Opioids should be minimized due to their potential side effects and risks 5, 6.
• NSAIDs are the most frequently recommended medication for the treatment of both acute and chronic low back pain as a first-line pharmacological therapy 6.

Non-Pharmacological Interventions

• Exercise therapies, such as physical therapy and multidisciplinary therapies, can reduce pain intensity and improve function for people with chronic low back pain 4.
• Psychological therapies, such as cognitive-behavioral therapy and progressive muscle relaxation, can also reduce pain intensity and improve function for people with chronic low back pain 4.
• Spinal manipulation and acupuncture may be used as adjuncts to improve acute low back pain 4, 5.

Recommendations

• The World Federation of Neurosurgical Societies (WFNS) Spine Committee recommends a uniform approach to the treatment of acute low back pain, including proper patient education and utilizing drugs with proven efficacy and minimal side effects 5.
• The WFNS Spine Committee also recommends continued activity, rather than bed rest, and the use of lumbar spine orthotics to reduce pain and augment functional status 5.