Nonspecific pain Patients with uncomplicated back pain should be encouraged to remain active and to return to normal activities. The
management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individual's ability to function in everyday activities, to help the patient cope with residual pain, to assess for side effects of therapy and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain at a manageable level to progress with rehabilitation, which then can lead to long-term pain relief. Also, for some people the goal is to use nonsurgical therapies to manage the pain and avoid major surgery, while for others surgery may represent the quickest path to pain relief. Not all treatments work for all conditions or for all individuals with the same condition, and many must try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of people with back pain (most estimates are 1–10%) require surgery.
Conservative Care Back pain is generally first treated with nonpharmacological therapy, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture and spinal manipulation therapy may be recommended. There is poor evidence for the effectiveness of most interventional treatments (drugs and surgery) for back pain and hence non-interventional treatments should be prioritized in the vast majority of cases. •
Heat therapy is useful for back
spasms or other conditions. A review concluded that heat therapy can reduce symptoms of acute and subacute low-back pain. • Regular activity and gentle stretching exercises is encouraged in uncomplicated back pain and is associated with better long-term outcomes. Physical therapy to strengthen the muscles in the abdomen and around the spine may also be recommended. These exercises are associated with better patient satisfaction, although they have not been shown to provide functional improvement. Supervised walking programs have been shown to be cost-effective at reducing back pain recurrences. •
Massage therapy may provide short-term pain relief, but not functional improvement, for those with acute lower back pain. It may also offer short-term pain relief and functional improvement for those with long-term (chronic) and subacute lower pack pain, but this benefit does not appear to be sustained after six months of treatment. •
Spinal manipulation appears to provide similar effects to other recommended treatments for chronic low back pain. There is no evidence it is more effective than other therapies or sham, or as an adjunct to other treatments, for acute low back pain • "Back school" is an intervention that consists of both education and physical exercises. There is no strong evidence supporting the use of back school for treating acute, subacute, or chronic non-specific back pain. • While
traction for back pain is often used in combination with other approaches, there appears to be little or no impact on pain intensity, functional status, global improvement or return to work.
Medication If nonpharmacological measures are ineffective, medication may be administered. However, caution should be undertaken with medications as long-term results of painkiller usage are worse than short-term. •
Non-steroidal anti-inflammatory drugs (NSAIDs) are typically attempted first. • Long-term use of
opioids has not been properly tested to determine efficacy for treating chronic lower back pain. However, they do not appear to be more effective than placebo. Opioids may not be better than NSAIDs or antidepressants for chronic back pain with regard to pain relief and gain of function. It is almost certain that over-prescription of opiates for conditions like back pain has been as a result of excess pharmaceutical company marketing rather than evidence of benefit, and many thousands of deaths have resulted. Back pain is considered one of the key conditions where opiate painkillers have been over-prescribed leading to the
Opioid epidemic. •
Skeletal muscle relaxers may also be used. However, the evidence of this effect has been disputed, and these medications do have negative side effects. ESI has long been used to both diagnose and treat back pain, although recent evidence, including a 2025 clinical practice guideline published in BMJ, recommends against the use of ESI for
chronic back pain due to a lack of efficacy.
Surgery Surgery for back pain is typically used as a last resort, when serious neurological deficit is evident. Surgery may sometimes be appropriate for people with severe
myelopathy or
cauda equina syndrome.
Total disc replacement can also be performed, in which the source of the pain (the damaged disc) is removed and replaced, while maintaining spinal mobility. When an entire disc is removed (as in discectomy), or when the vertebrae are unstable, spinal fusion surgery may be performed.
Spinal fusion is a procedure in which
bone grafts and metal hardware is used to fix together two or more vertebrae, thus preventing the bones of the spinal column from compressing on the spinal cord or nerve roots. If infection, such as a
spinal epidural abscess, is the source of the back pain, surgery may be indicated when a trial of antibiotics is ineffective. Surgical evacuation of spinal
hematoma can also be attempted, if the blood products fail to break down on their own. ==Pregnancy==