Treatment for Acute Low Back Pain

Patients with short-term acute low back pain usually have the best results with the least aggressive treatments. The general approach is as follows:

Patients with no serious underlying cause should stay as active as possible within the limits of the back pain. (Bed rest is not recommended.) Some studies suggest that a third of patients with uncomplicated low back pain get significantly better after a week with no other treatment than normal activity. Two-thirds of patients with uncomplicated low back pain have recovered by the seventh week.
Physical therapy or spinal manipulations may be helpful if pain continues for more than 2 to 3 weeks.
The patient should seek a specialist if pain continues for more than 1 month. (Some patients may need to see a specialist sooner if there is an underlying disorder, nerve damage, or injury.)

text continues below

Back pain due to medical conditions such as arthritis, osteoporosis, or pregnancy either goes away when the underlying condition disappears or is treated.

Immediate Treatment of Acute Low Back Pain of Unknown Cause

Experts now recommend that people with acute low back pain attempt to resume normal activities as soon as possible. They should be conducted without strain or stretching. Let pain be the guide. In general, normal activity should be resumed in a gradual fashion as soon as the patient feels ready. Therapeutic exercises should not begin until after the acute pain has gone away.

Specific Tips for Relieving Pain

Bed rest is no longer recommended and may delay recovery. Patients may need to stop normal physical activities for a few days, but in general should remain as active as possible.
Over-the-counter pain relievers, usually the nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil and others) often provide significant benefits. Muscle relaxants may be helpful in some patients, although their benefits are uncertain. Once started, medications should be taken on a regular schedule in order to maintain consistent effectiveness.
Application of heat (104 degrees) can be very helpful, and may be more effective than ibuprofen or acetaminophen (Tylenol). Research out of Johns Hopkins University found that people with low back pain who wear low-level heat wraps for 8 hours a day have significant less pain and disability. The study specifically looked at ThermaCare HeatWraps, which are available over-the-counter. The wraps are worn around the lower back, underneath clothing.
Some doctors recommend changing from hot to cold (ice packs) every 3 minutes and repeating this sequence three times. (Some experts believe ice packs should be applied first.) This routine should be performed two or three times during the day. (Heat or cold treatments do not have much effect on sciatica.)
Supportive back belts, braces, or corsets may help some people temporarily, but these products can reduce muscle tone over time and should be used only briefly.
Healthy sleep plays a vital role in recovery. It is often difficult to get a good night's sleep when suffering from back pain, particularly because the pain can intensify at night. Take a warm bath before bedtime, and practice relaxation techniques. It may be necessary to take medication to help manage nighttime pain or treat sleeplessness. To help promote sleep, avoid caffeine in the afternoon and evening. Lying curled up in a fetal position with a pillow between the knees or lying on the back with a pillow under the knees may help.
Massage therapy may be helpful for many people with both acute and chronic low back pain. In fact, three well-conducted studies demonstrate some benefit and suggest it may reduce the costs of care. However, it may not be covered by health insurance.
Spinal manipulation may be helpful, although it is not clear if it is any more helpful than physical therapy or general care. Some experts recommend delaying this treatment until pain has persisted for 3 weeks, if possible, since the back pain will most likely have gone away on its own by then.