The best way to recover from the most common kinds of back pain, the mechanical sort, is to stay as active as possible, even though it hurts. Studies show that people with a new or recurrent episode of pain who followed this advice had significantly less pain within three to four weeks compared to people who rested in bed.
The main purpose of medications for back pain is to increase your function by controlling symptoms and increasing your mobility during the healing process. Increased activity speeds recovery. So the purpose of the medication is not just to stop the pain, it is to stop the pain so you can start to move. It is up to you to take advantage of the opportunity. All drugs—both over-the-counter and prescription products—have potential side effects and may not be recommended for people with other health problems. Here are the drugs most commonly used for back and back-related leg pain:
- Over-the-counter pain relievers
These include aspirin or acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. While NSAIDs have sometimes been found effective in relieving back symptoms, their benefits must be weighed against the known risks of long-term use—mainly gastrointestinal (stomach) bleeding and cardiovascular problems. Although these products are available without prescription, they should always be used according to package directions and with the advice of your family physician.
- For stronger medication, you’ll need a prescription from your family doctor. He or she may suggest you try one or more of the following products:
- Opiod pain-killers
These include codeine (often combined with acetaminophen) and strong pain killers such as oxycodone. Narcotic medication may be indicated for a short time for leg dominant pain due to nerve root irritation but should not be used for mechanical back dominant pain. These drugs have potentially serious risks, including dependency or even addiction, so it’s important to discuss both the risks and the benefits with your doctor.
Many people with chronic back pain who develop a complex pain pattern suffer anxiety and trouble sleeping. These people may benefit from an antidepressant. These medications may encourage better sleep and help control your emotional response to your pain but they have significant side effects and must be used with care. Fortunately most back pain sufferers don’t need them.
- Muscle relaxants
These products are available in both over-the-counter and prescription form and are sometimes recommended for short-term use. Since these medications can’t specifically target muscles in the back, their main value is probably as a “total body relaxer.” They do tend to make you sleepy, which can be a problem for many people during the day, especially if you drive or need to concentrate. In any case, you should avoid taking them for longer than a few days or a week.
A variety of back exercises and body movements can help control mechanical back pain.
You can use certain positions and general movement as a form of pain relief. For example, if bending backwards seems to ease your symptoms, try lying on your stomach and using your arms to raise your head and shoulders while keeping your hips on the floor. If you find that bending forwards eases your symptoms, try sitting in a chair and slumping forward to rest your chest on your knees. This can be done frequently throughout the day.
Back muscle exercises
The muscles in your back work together to balance, stabilize, align and move your body. These muscles also provide support for the spine. For chronic or frequently recurring back pain a program of exercise, designed to strengthen these muscles may reduce symptoms over time. Some people report that such a regimen has protected them from further episodes of back pain. Performing these muscle-strengthening exercises isn’t hard, but you’ll need to be taught the technique by a health care provider. After that, you will need to do them on your own at home.
It is important to differentiate between pain controlling movements and strengthening exercises. Strength training, for your back, your legs or your whole body may be a way to minimize further episodes. It is NOT a way to control the pain of an acute attack. Strengthening exercises are good for many people, maybe for you – but maybe not just yet.
Manipulation, also known as mobilization, may help control some types of joint and muscle-related pain including back pain. (Other mobilization therapies include traction and massage.) During treatment, the therapist uses the hands to apply a controlled force to the patient’s back, which may result in short-term pain relief. This treatment is usually provided by chiropractors, physiotherapists osteopaths or medical doctors. While there is evidence that a course of manipulation helps some people with back pain there is no evidence it has long term or preventative benefits.