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owing therapies may be useful for home treatment of back pain:

• Over-the-counter pain medications such as paracetamol may help control pain, and mild nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen 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.
• Alternating heat and cold application can help relieve sore and inflamed back muscles. Immediately after back pain starts up, try applying ice compresses several times a day, up to 20 minutes each time. After spasms and acute pain subside, apply heat for up to 20 minutes to help loosen tight muscles.
• 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 (less than 1 week) 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.
• 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. 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
• Healthy sleep is important in recovery. It is often difficult to sleep when suffering from back pain, particularly when pain intensifies at night. Try lying in a fetal 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.

• Medications. Your doctor may prescribe nonsteroidal 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 or physical therapist 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. Only 2% of back pain investigation results in a back operation. Certain conditions that do not respond to other treatments may benefit from surgery: these include unrelenting pain or progressive muscle weakness caused by nerve compression, or incontinence (which can indicate spinal cord irritation).
  Laminectomy and fusion are among the most commonly performed back surgeries. Laminectomy aims to relieve sciatica by removing bone spurs or disc fragments that protrude into the spinal canal or 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 usually good results. However, long-term outcomes are often similar following less-invasive treatments.
• Spinal manipulation is use of the hands 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 an orthopaedic specialist.

Reviewed by Dr Sirk Loots, orthopaedic surgeon.

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