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- In many cases, it is not necessary to see a doctor for back pain because pain usually goes away without treatment. However, an individual should see a doctor if they experience numbness or tingling, severe pain, or pain that does not improve with medication and rest. Also, individuals should see a doctor if they have pain after a fall or an injury. It is also important to see a doctor if pain occurs along with any of the following problems: trouble urinating; weakness, pain, or numbness in the legs; fever; or unintentional weight loss. Such symptoms could signal a serious medical condition that requires treatment.
- Applying ice as soon as possible during the 48 hours after straining a muscle can reduce pain. Ice slows inflammation and swelling, numbs soft tissue, and slows nerve impulses in the injured area. After spasms and acute pain subside, heat can be applied to loosen tight muscles. Over-the-counter (OTC) pain-relieving medications, such as acetaminophen (Tylenol ®), ibuprofen (Advil ®), or naproxen (Aleve ®), may be used for short-term (less than two weeks). Two or three days of bed rest followed by a gradual return to normal activity is sometimes recommended.
- Physical therapy and exercise: A physical therapist may apply a variety of treatments (such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques) to the back muscles and soft tissues to reduce pain. As pain improves, the physical therapist can teach the individual specific exercises to increase flexibility, strengthen the back and abdominal muscles, and improve posture. Regular use of these techniques may help prevent pain from coming back. Exercise can correct current back problems, help prevent new ones, and relieve back pain, particularly after an injury. Exercise also strengthens bones and reduces the risk of falls and injuries.
- Prescription medications: A doctor may prescribe non-steroidal anti-inflammatory drugs (such as flurbiprofen or Ansaid ® and celexocib or Celebrex ®), muscle relaxants (such as cyclobenzaprine or Flexeril ®), and narcotic pain relievers (such as hydrocodone or Lortab ®). A skin patch containing an opioid called transdermal fentanyl (Duragesic ®) may relieve chronic back pain more effectively than oral opioid drugs. Muscle relaxants, opiate agonists, and narcotic pain relievers may cause drowsiness. Narcotic pain relievers may also cause physical dependence and should be used with caution. Corticosteroid injections (steroids, such as dexamethasone or Decadron ®) may be used if pain-relieving and anti-inflammatory medications do not offer relief. The long-term use of steroid medications can cause complications such as weakened immune systems and swelling.
- Tricyclic antidepressants, such as amitriptyline (Elavil ®) and nortriptyline (Pamelor ®), may be used for numbness, burning, aching, throbbing, or stabbing pains that shoot down the limbs. Side effects of these drugs include drowsiness, dry mouth, blurred vision, and constipation.
- Surgery: Few individuals need surgery for back pain. Surgery is usually reserved for pain caused by a herniated disk. If the individual is experiencing unrelenting pain that is unable to be relieved by medications or progressive muscle weakness caused by nerve compression, surgery may be beneficial.
- Disc removal: There are three common types of surgeries that involve the removal of damaged or herniated discs in the spine, including laminotomy, laminectomy, and disectomy. A laminotomy is the surgical removal of part of the lamina (bony arch) above and below an affected nerve. A laminectomy consists of the surgical removal of most of the lamina of a vertebra. A laminectomy is most often performed when back pain fails to improve with more conservative medical treatments such as pain medications and physical therapy. A discectomy is the surgical removal or partial removal of a spinal disk.
- Fusion surgery: Fusion surgery involves joining two vertebrae to eliminate painful movement. Recovery following fusion surgery generally takes longer compared to other types of spinal surgery. Patients typically stay in the hospital for three or four days, but a longer stay after more extensive surgery is not uncommon. A short stay in a rehabilitation unit after release from the hospital is often recommended for patients who have had extensive surgery, or for elderly or debilitated patients. Pain from surgery varies.
- Intradiscal electrothermal therapy (IDET): In intradiscal electrothermal therapy (IDET), doctors insert a needle through a catheter into the damaged spinal disk. The needle is heated to a high temperature for up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation. It is unclear whether this treatment is effective for back pain.
- Implanted pumps: Pumps may be implanted into the spinal area to deliver a constant flow of pain-relieving medications (such as opiates like morphine). Surgically implanted spinal cord stimulators modulate the pain response so that the individual with a back condition experiences less pain. The implantation may put the individual at an increased risk for infection.
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