Back Pain

Updated 12 May 2016

Treating back pain

Learn more about home treatment, medication, physical therapy, surgery and more.

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Because most back problems aren't serious, doctors often recommend home treatment first. Approximately eighty percent of back pain resolves spontaneously within six weeks.

Home treatment:

The following treatment regimes may offer some relief in treating back pain at home:

- Lie down in a comfortable position at the onset of back pain. However, bed rest for longer than a few days is not recommended as this can reduce your muscle strength and lead to further disability.

- Alternating heat and cold applications can help relieve sore and inflamed back muscles. Immediately after back pain starts, try applying ice compresses several times a day for up to 20 minutes at a time. After spasms and acute pain subside, apply heat for up to 20 minutes to help loosen tight muscles.

- Over-the-counter pain medications such as simple analgesics (paracetamol) may help control pain, and non-steroidal anti-inflammatory drugs (NSAIDs) can reduce muscle and joint inflammation. Consult your doctor about long-term use of even non-prescription medications, especially NSAIDs, as these can have significant side effects – especially if you have hypertension, cardiac or renal disease or a history of peptic ulcer.

- Back braces, corsets and belts can relieve strain and support your back temporarily. Prolonged use may result in weakened muscles, so limit use of these aids to short periods or during back-straining activities. Braces and corsets are available over the counter at pharmacies and medical supply stores. Your doctor may prescribe a customised brace or you could consult an orthotist

When the pain lessens:

- Try to get moving again as soon as possible, but increase your activity levels gradually.

- Try not to stay in one position or do any activity for more than 30 minutes at a time.

- Avoid lifting, bending or twisting until you have been pain-free for a few days.

- Avoid the activity which caused the pain for a couple of weeks.

A healthy sleeping pattern is beneficial in recovery. It is often difficult to sleep when suffering from back pain, particularly when pain intensifies at night. Try lying in a foetal position with a pillow between your knees, or lying on your back with a pillow under your knees. Avoid caffeine, try having a warm bath before bedtime, and practise relaxation techniques. Medication may be necessary to help manage night-time pain and sleeplessness.                    

Contact your doctor if pain does not improve after about a week with home treatment.

When self-treatment isn't enough, you may need professional treatment that could include some of the following therapies:

Medication. Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants to relieve mild to moderate back pain and muscle spasm. Corticosteroid injections may be prescribed for more severe back pain.

Physical therapy may include:

- Heat and cold applications

- Massage performed by a physical therapist

- Hydrotherapy: exercises done in a special swimming pool. Warm water helps support damaged tissues and provides resistance for exercises.

Exercise. Once the pain subsides, your doctor, physiotherapist or biokineticist can design an exercise programme to improve muscle strength, flexibility and posture.

Relaxation can loosen tense muscles and ease pain, and help you learn to cope better with chronic pain.

Electrical stimulation: Transcutaneous electrical nerve stimulation (TENS) acts by interfering with transmission of pain signals. Electrodes are placed on your skin near the painful area, 

and a mild electric current is passed through them. TENS may relieve sciatica pain, but usually provides little relief from chronic back pain.

Surgery

is unnecessary in most cases of back pain. Less than 5% of back pain patients will need an operation. Certain conditions that do not respond to conservative treatment may benefit from surgery: these include unrelenting pain, muscle weakness (caused by nerve compression), or bladder/bowel disturbance (caused by compression of a bundle of nerves called the cauda equina).
 
Laminectomy and fusion are among the most commonly performed back surgeries. Laminectomy aims to relieve leg pain by removing bone spurs or disc fragments that protrude into the spinal canal and press on nerve roots. 

Fusion involves joining two vertebrae with a metal implant and bone graft to eliminate painful movement. 

Before deciding on back surgery, consider getting a second opinion. Surgery to remove a herniated disc, for example, is a frequently performed procedure with good results. However, long-term outcomes are often similar following less invasive treatments.

Spinal manipulation is when the hands are used to apply force to the back. Manipulation should only be carried out by an appropriately trained doctor, physiotherapist, osteopath or chiropractor and must be done in consultation with a neurosurgical or orthopaedic spine specialist.

Read more:

Preventing back pain  

Diagnosing back pain 

Causes of back pain

Reviewed by Dr Pradeep Makan, orthopaedic surgeon, Melomed Gatesville and Life Vincent Pallotti Hospital in Cape Town and part-time lecturer in the department of orthopaedic surgery at the University of Cape Town, 2016.

 

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Susan qualified as a Physiotherapist in 1990, and completed her master’s degree in Physiotherapy in 2013 at the University of Pretoria. She has a special interest in human biomechanics, as well as the interaction between domestic and work-related ergonomics.

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