Back pain: Management

Woman holding back

Managing back pain

Back pain frequently resolves within a few weeks or months.1,2

However, sometimes the pain can persist over the long term, or keep recurring.1

Here we review physiotherapeutic and pharmacological treatment options to help your patients manage their back pain.2–4

Guideline recommendations for treating back pain

Graphic summarising treatment pathway for back pain

Guidance on managing back pain recommends multimodal intervention

Recommendations from the National Institute for Health and Care Excellence and the American College of Physicians are available guiding the pharmacological and non-pharmacological management of lower back pain.2–4

This advice covers several modes of intervention:

  • Exercise
  • Pharmacological treatments
  • Manual therapy
  • Physical and/or psychological therapy
  • Exercise

    Resting for long periods can make back pain worse.1

    Certain forms of exercise can relieve pain and improve function as part of a multidisciplinary rehabilitation approach.3

    Walking, swimming, yoga and pilates are activities that may be particularly helpful for back pain.1

    Specific exercises and stretches are also available for relieving back pain.1

  • Pharmacological treatments

    Guidelines recommend that oral non-steroidal anti-inflammatory drugs (NSAIDs) are considered for managing lower back pain.4

    Weak opioids with or without paracetamol may be considered for acute lower back pain but only if NSAIDs are contraindicated, not tolerated or ineffective.4

  • Manual / physical therapy

    Manual therapies, which involve massage and manipulating the spine, can be considered as part of a treatment package that also includes exercise.1,2,4

    Manual therapy can be provided by physiotherapists, chiropractors or osteopaths.

  • Heat

    Several guideline bodies recommend application of low-level superficial heat for back pain relief.1,3,5,6

    Indeed, superficial heat is the only non-pharmacological treatment for lower back pain that is rated as having a good evidence of efficacy.5,6

    Find out more

  • Psychological therapy

    Psychological interventions such as cognitive behavioural therapy can be helpful for coping with the pain, as part of a treatment approach that also includes manual therapy and exercise.1,4

Understanding back pain

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Find out about the causes of back and neck pain.

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Signs and symptoms

Explore an overview of how to recognise back and pain and know when to refer patients.

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Overview of sprains and strains

Find out about how prevalent sprains and strains are, and meet two patients with these problems.

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Voltaren Triple Effect

Voltaren Triple Effect

Find out about topical diclofenac 1.16% emulgel and how this can be used to relieve strains and sprains.

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