Do any non-drug treatments help back pain?

Is back pain likely to be serious?

There are different types of low back pain. It can:

• be short-lived, lasting less than six weeks (acute back pain)
• linger for a bit longer, for six to twelve weeks (sub-acute)
• stick around for months and even years (chronic, defined as more than 12 weeks).

In most cases (90-95%), back pain is non-specific and cannot be reliably linked to a specific cause or underlying disease. This includes common structural changes seen in x-rays and MRIs of the spine.

What helps for short-term back pain

1. Stay active – don’t rest in bed

If your back pain is new, the best advice is also one of the simplest: keep moving despite the pain.

Changing the way you move and use your body to protect it, or resting in bed, can seem like the right way to respond to pain – and may have even been recommended in the past. But we know now this excessive protective behavior can make it harder to return to meaningful activities.

This doesn’t mean pushing through pain or hitting the gym, but instead, trying to maintain your usual routines as much as possible. Evidence suggests that doing so won’t make your pain worse, and may improve it.

2. Multidisciplinary care, if pain lingers

For pain lasting six to 12 weeks, multidisciplinary treatment is likely to reduce pain compared to standard care.

This involves a coordinated team of doctors, physiotherapists and psychologists working together to address the many factors contributing to your back pain persisting:

• neurophysiological influences refer to how your nervous system is currently processing pain. It can make you more sensitive to signals from movements, thoughts, feelings and environment
• psychological factors include how your thoughts, feelings and behaviors affect your pain system and, ultimately, the experience of pain you have
• occupational factors include the physical demands of your job and how well you can manage them, as well as aspects like low job satisfaction, all of which can contribute to ongoing pain.

What works for chronic back pain

Once pain has been around for more than 12 weeks, it can become more difficult to treat. But relief is still possible.

Exercise therapy

Exercise – especially programs tailored to your needs and preferences – is likely to reduce pain and help you move better. This could include aerobic activity, strength training or Pilates-based movements.

It doesn’t seem to matter what type of exercise you do – it matters more that you are consistent and have the right level of supervision, especially early on.

Multidisciplinary treatment

As with short-term pain, coordinated care involving a mix of physical, occupational and psychological approaches likely works better than usual care alone.

Psychological therapies

Psychological therapies for chronic pain include approaches to help people change thinking, feelings, behaviors and reactions that might sustain persistent pain.

These approaches are likely to reduce pain, though they may not be as effective in improving physical function.

Acupuncture

Acupuncture probably reduces pain and improves how well you can function compared to placebo or no treatment.

While some debate remains about how it works, the evidence suggests potential benefits for some people with chronic back pain.

What doesn’t work or still raises uncertainty?

The review found that many commonly advertised treatments still have uncertain benefits or probably do