Four out of five Americans have  experienced low-back pain..  For some, acute low-back pain…lasting one to three months…turns into chronic low-back pain a long- term problem that can limit activity and interfere with sleep.  Back pain is the number-two symptomatic reason for doctor visits, right behind colds.

PROBLEM: The help that most doctors offer is pills…. either over-the-counter painkillers, powerful muscle relaxants or even addictive opioid painkillers.

In February 2017, the American College of Physicians issued new guidelines for treating low-back pain….recommending nondrug treatments as a first choice for acute pain and often for chronic pain too.

Research shows that many medications commonly prescribed or recommended by doctors for low-back pain don’t work to relieve the pain.  Opioid medications …they’re dangerously addictive , more than 16,000 Americans die yearly from overdoses.  Some medication can help a bit. Ibuprofen, naproxen or aspirin provide some relief for low-back pain.  Muscle relaxants also are moderately effective. If you have a classic case of low-back pain, you often don’t need medication.

MISLEADING IMAGING:  Getting an imaging test such as an MRI, a CT scan or an x-ray usually is not a good strategy for diagnosing acute low-back pain.  Yes, the imaging may detect an abnormality such as a bulging disk in the spine. But such abnormalities are common and may not be the cause of the low-back pain and treating them may lead to unnecessary tests and invasive procedures, even surgery, that are not needed.  There are several serious problems that can cause back pain and are considered medical emergencies, such as tumors  If you have muscle weakness in the foot or the leg and have back pain, you may have a disk problem that requires further treatment.


The American College of Physicians now recommends these treatments.

Wait it out: The little used but effective strategy for most cases of acute back pain is…don’t go to the doctor initially. Low-back pain almost always improves on its own within a month or so.

Exercise: There is good scientific evidence that exercise can help relieve chronic low-back pain.  Beneficial types of movement include aerobic exercise, such as brisk walking or bicycling…yoga or stretching …and exercises that strengthen your abdominal and spinal muscles such as Pilates.

For acute back pain, specific back exercises may not be helpful, it is wise to keep walking and maintain normal activities as much as possible. It is when pain becomes chronic that exercise seems most helpful.

Cognitive behavioral therapy (CBT) or mindfulness-based stress reduction (MBSR):  A regimen for chronic low-back pain is often a combination of exercise and a mind-body approach such as CBT( a psychological therapy that helps you identify dysfunctional patterns of thinking and behavior that increase your pain) or MBSR ( which combines the non judgmental acceptance of experience with relaxation techniques).  By helping you pace yourself in daily life, these techniques ease muscle tension, relieve depression (common in people with chronic pain) and improve sleep.

Hands-on professionals:  Research shows that spinal manipulation,( other professionals besides chiropractors such as osteopathic physicians or physical therapists may do manipulation),  acupuncture, massage therapy and other hands-on healing techniques can help relieve both acute and chronic back pain.

Optimism:  A recent study published in Spine revealed that seniors with low-back pain are more likely to get better if they are confident that their treatment will work.

If Pain persists:  for more than a month without significant improvement  it is wise to see a doctor.  See a doctor immediately if you have weakness in the foot or the leg and back pain, it may be a disk problem. Also,unexplained fever or weight loss and back pain,may be an infection of the spine or a tumor.

If your doctor says you need medication, ask “what are the relative risks and benefits of this choice?” “what will happen if I don’t take the medication? What are the alternatives?”

If surgery is recommended, consider getting a second opinion.  The most common  surgery for back pain is spinal fusion, which is invasive and extensive with a long recovery period.

Even worse:  Research shows that the surgery is of questionable effectiveness for many back problems.  It also shows that a rigorous rehabilitation program…involving physical therapy and training in pain management works just as well.

Best of all “control the core” stabilize your pelvic muscles and create an awareness of proper posture with daily activities including recreational activities.