Getting Back at Back Pain

15 suggestions to find back pain relief

Back pain is a thief. It can rob you of a good night's sleep, an honest day's work or the ability to give a child a piggyback ride.

An estimated 50 percent to 80 percent of American adults will have back pain at some point. For some, it will set up shop slowly. For others, it will come on suddenly and with great force.

Back pain can be crafty, using many circumstances to get into your life – a traumatic accident, a simple sprain or strain, fibromyalgia, arthritis of the spine, a fractured vertebra or ruptured disc.

Fortunately, no matter the cause, you can find back pain relief and, in many cases, keep back pain from returning.

Sometimes, fighting back pain requires quick and aggressive action. If you have an infection, tumor of the spine or a condition called cauda equina syndrome (in which the nerve roots that supply the bladder and bowel are compressed) you may need surgery right away. But in most cases, you have time to try several options.

"About half the time, back pain gets better within two weeks," says David Borenstein, MD, clinical professor of medicine at George Washington University Medical Center in Washington, D.C. "About 80 percent of the time it improves within two months."

Whether you've been in pain just a few days or beyond the two-month point, the following suggestions may help you ease your pain. Try a few of these 15 options to get back at back pain. As the old saying goes, "Living well is the best revenge

1. Some like it hot

For some people, nothing soothes a sore back like heat. In a recent study published in the journal Spine, researchers at the University of Medicine and Dentistry of New Jersey – New Jersey Medical Center (UMDNJ-NJMC) discovered that the continuous (eight hours daily) application of low-level heat (104 degrees F) eased acute back pain better than either of two commonly used drugs, ibuprofen and acetaminophen.

Heat may be dry or moist. Dry heat sources include heat lamps, heating pads or "wearable" disposable heat packs such as ThermaCare wraps or Grabber MyCoal. Moist heat sources include warm baths and washcloths soaked in warm water. See which works best for you.

Soaking in a warm tub can be a good way to apply heat to all parts of the body at once -especially if you ache all over with fibromyalgia or if you have arthritis in several joints as well.

If you find that pain and stiffness are worst in the morning, try warm-water therapy when you wake up. If pain increases through the day, a warm soak before bedtime might make it easier to get to sleep. Some people, including those in the UMDMJ-NJMC study, find that continuous heat administered by a wearable heat pack eases pain and stiffness all day.

2. Go for the cold

When back pain is severe, applying something cold can reduce pain and swelling by restricting the blood vessels and preventing fluids from leaking into the surrounding tissues. Cold therapy can also numb the affected nerves and distract your mind from the source of your pain.

But using ice for too long can cause stiffness, says Dr. Borenstein. He recommends using cold for pain associated with an injury and limiting it to the first 24 to 48 hours after pain starts. "As the process moves along, you'll want to switch to heat, which can increase blood flow to a certain degree and help movement."

Cold may be applied with a commercially available cold pack, or you can make your own cold pack by wrapping a towel around a bag of frozen peas or filling a sealable sandwich bag with ice. Judy Piette, a physical therapist in Atlanta, recommends a combination of heat and cold for her patients with painful muscle spasms. "I have them use heat for 20 minutes, do gentle exercises and then use ice for 20 minutes," she says.

For best results, and to avoid causing damage to the skin, apply cold packs for no more than 15 to 20 minutes at a time, and always put a towel between your skin and the cold pack.

If you have poor circulation, vasculitis or Raynaud's phenomenon, speak to your doctor or other health professional before applying cold therapy.

3. Get physical

If you have back pain or are recovering from surgery, physical therapy can help strengthen the muscles in your back to help relieve back pain or regain motion.

A physical therapist will tailor exercises to your particular condition.

Recent research shows that exercises designed to strengthen back muscles may be useful even if you don't have back pain yet. In a recent study of 50 women between the ages of 58 and 75, those who performed back-strengthening exercises suffered fewer painful fractures of the vertebrae than women who didn't do the exercises.

4. Work out in water

You know how good it feels to soak in warm water, especially when your back is aching. It turns out that warm water may also be a good place to stretch and strengthen your back muscles.

By allowing your muscles to relax, warm water provides an excellent environment for exercise – even for those who have difficulty exercising on dry land. Water acts as resistance to help build muscle strength, and the buoyancy makes it feel easier and more comfortable to exercise.

A recent study by Japanese researchers shows that exercise, whether on land or in water, decreases pain levels, increases the body's production of inflammation-fighting hormones and decreases anxiety, which can exacerbate back pain.

To get a good full-body workout in the water, you'll need access to a heated pool. (Call your local Arthritis Foundation office at 800/283-7800 and ask about the Aquatics Program). You can do warm-water exercise on a smaller scale in your own tub, spa or whirlpool bath.

5. Ahhh...there's the rub

Who couldn't benefit from a good back rub? Massage can relax tight, painful muscles, making movement easier. It also relieves stress, and is one of the most widely-used – and perhaps most useful – therapies for back pain.

In a recent study by researchers at the University of Miami School of Medicine, chronic back-pain patients who received two 30-minute massage sessions per week for five weeks reported less pain, anxiety, depression and better sleep than a control group. They also demonstrated better low-back flexibility and had higher levels of the pain-relieving hormones, serotonin and dopamine.

When most people think of massage, they think of Swedish massage, a full-body treatment that involves kneading the top layers of muscles through a layer of oil or lotion. But there are several other types of massage, including deep-tissue massage, neuromuscular massage and myofascial release.

Some massage therapists are trained in certain forms of massage. If you have a condition such as ankylosing spondylitis or osteoporosis of the spine, however, ask your doctor to refer you to a massage therapist who has experience working with your particular condition.

6. Restrict movement

People with a back condition that requires stability may benefit from a brace or corset at some point. Several types (elasticized, close-fitting undergarments that support the lower hips, lower back and abdomen) typically can be worn under your clothing.

Corsets are adjustable and made of elastic; braces are sturdier and have metal stays. Both are used for the same purposes: to reduce pressure on the discs, small, circular cushions of tissue that act as shock absorbers between the vertebrae (the bones of the spine); provide back and abdominal support; and keep the spine stable while it heals.

Braces are often prescribed for temporary pain relief, especially during times you'll be particularly active or sitting for long periods of time. They are also prescribed as a way to restrict movement of the spine during recovery from a fractured vertebra or some surgeries.

7. Look to the East for exercise

One of the best things you can do for back pain is move – gently and in moderation. Many people have found a way to do that by looking to newly trendy, but actually ancient forms of movement such as yoga and tai chi.

Some yoga exercises gently stretch and strengthen the muscles in the hips, back and legs; others improve muscle strength in the abdomen, which supports the lower back.

Yoga's breathing exercises, postures and meditation practices, when performed daily, have been shown to improve flexibility and balance, regulate heart rate, lower blood pressure and decrease anxiety, which can worsen back pain.

For people with osteoporosis, in whom a fall could mean a serious and painful fracture, tai chi has an added benefit – improving balance. In a large study sponsored by the National Institute on Aging, seniors who practiced tai chi suffered 25 percent fewer injuries from falls than control groups.

To find out if the Arthritis Foundation's new tai chi program will be available in your area, contact your local office.

8. Rest up – but don't overdo it

When your back hurts, you might want to do nothing but lie still. While that might not be a bad idea for a bit, resting too long can make pain linger longer than necessary.

"One of the major myths about back pain is that resting exclusively is the way to get better," says Dr. Borenstein, author of Back in Control! A Conventional and Complementary Prescription for Eliminating Back Pain (M. Evans, 2001). "We have come to realize is that rest and activity actually go hand in hand. You have to have an appropriate amount of both. You can't just lie down for weeks and expect to get better, but this also isn't the time to go out and sign up for a high-impact aerobics class."

Just getting up, walking and stretching can get the heart pumping and get oxygen to painful tissues to help them start healing, he says. Exercise can also help by increasing your body's production of its own natural painkillers called endorphins.

9. Lose weight, if you need to

The benefits of weight loss are probably greatest for people with the most weight to lose, but even those who carry around an extra 10 or 20 pounds could benefit from losing weight. Keep in mind that elaborate weight-loss plans are a distraction from the real key to losing weight – that is, burning more calories than you consume or consuming fewer calories than you burn.

For most people, that means increasing your level of exercise, while decreasing the amount you eat. A plus: The exercise you do to lose weight will likely have pain-relieving benefits of its own by producing endorphins.

10. Stop smoking

Thought you'd heard all of the reasons there were to stop smoking? Well, here's another: Smoking is bad for your back.

Smoking decreases oxygen to the various tissues that have difficulty getting oxygen in the first place such as the discs in your spine. "Discs that are deprived of oxygen are likely to degenerate, and discs that degenerate may cause pain down the road," says Dr. Borenstein. Smoking may also weaken the ligaments (tough bands of connective tissue that attach bones to one another) that support the spine, leading to instability.

Research has shown a high prevalence of spinal stenosis (a condition where the spinal canal is not large enough for the spinal cord) among smokers, and smoking is also a risk factor for osteoporosis, which can lead to painful vertebral fractures. Another negative: If you have a back problem that eventually requires surgery, studies show smoking slows the healing process.

11. Learn to relax

There's no denying it: Being under stress can add to pain. Regardless of what causes pain, stress can make it worse or keep it around longer than necessary. "Stress heightens our awareness and feelings of discomfort," says Dr. Borenstein. And feeling pain adds to stress.

To help break this vicious cycle, try relieving stress by writing in a journal, talking with a counselor or trying the following relaxation techniques:

Guided imagery. Guided imagery helps take your focus off your stress and pain, by taking you to a mental journey to a beautiful, safe and pain-free place – perhaps the mountains where you vacationed as a child, the beach where you spent your honeymoon or the tropical island you have always dreamed of visiting. Imagine the place in as much detail as possible – the sights, the sounds, the feeling of the sand beneath your bare feet or the cool mountain air on your face. Take several deep breaths and enjoy feeling calm and peaceful before you open your eyes.

Progressive relaxation.  In progressive relaxation, you progressively tense and relax your body's muscles from head to toe. Begin with the muscles of your feet and calves, tensing and gradually relaxing them, and then continue until you have tensed and relaxed the muscles of your neck and face. Breathe deeply as you go.

12. Get the point

Getting stuck with needles may seem more like a way to receive pain than a way to relieve it, but if other therapies haven't helped your pain, you may want to give acupuncture a try. A key component of Chinese traditional medicine, acupuncture involves inserting thin needles at particular points (called acupoints) on the body. Sometimes the needles are connected to a low-level electrical current (electroacupuncture) for a more powerful effect.

According to Chinese theory, stimulating acupoints can correct the flow of essential life energy called qi (pronounced "chee") to optimize health or block pain. Western doctors believe acupuncture more likely works by prompting the body to release pain-relieving substances called endorphins.

Acupuncture has gained credibility in the medical community.

A National Institutes of Health panel concluded that acupuncture could help in the treatment of musculoskeletal conditions, such as back pain and even fibromyalgia without the side effects of medications.

If you want to try acupuncture, make sure your acupuncturist is certified (the major certifying board for acupuncturists is the National Certification Commission for Acupuncture and Oriental Medicine), is licensed by your state and uses sterile, disposable needles.

13. Don't deny yourself medication

Many of us would like to get better without ever popping a pill. But even the most effective pain-relief techniques are useless if you are in too much pain to try them. While most people don't need medications long term, using them for a short time can help ease your pain enough to get you up and moving.

Medications for back pain include the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs). Examples: ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn)

Analgesic (pain-relieving) drugs. Examples: over-the-counter acetaminophen (Tylenol), narcotic drugs such as acetaminophen with codeine (Fioricet), hydrocodone with acetaminophen (Lortab, Vicodin)

Antidepressants. Examples: amitriptyline (Elavil), nortriptyline (Pamelor)

Muscle relaxants. Examples: cyclobenzaprine (Flexeril), carisoprodol (Soma)

Topicals. Examples: capsaicin (Zostrix, Zostrix HP), salicylates (Aspercreme, BenGay, Flexall)

Too often people take medications as their only line of defense against pain, says Dr. Borenstein. "What medications are supposed to do is make your back less painful so you can do the things you need to get better."

Most people who take medications for back pain don't need them long term; however, if you take NSAIDs for arthritis, a disease-modifying drug for ankylosing spondylitis or an antidepressant for fibromyalgia, you may need to continue taking it for other aspects of your condition even when back pain is better.

14. Start off on the right foot

Do you have back pain after standing or walking? Take a look at your shoes. Wearing shoes with high heels or heels with uneven wear can throw off your posture and put unnecessary stress on your back – and your knee joints as well.

If you spend a lot of time on your feet, picking a comfortable shoe may not be enough; you may benefit from placing an orthotic device into your shoe. In a study of postal workers who had trouble with foot, leg and/or back pain after long hours on their feet, using a three-quarter-length insert of polyurethane led to a 67 percent decrease in back pain. Shoe inserts, such as Dr. Scholl's Stepwell Insoles, come ready made or you can have one designed by a physical therapist especially for your needs.

15. Allow yourself to be manipulated

Both chiropractors and osteopathic physicians use manipulation to ease back pain, although the way they do it varies. Osteopathic manipulation often involves massaging the soft tissues (such as muscles) about the spine, whereas chiropractic involves manipulating the ligaments and vertebrae of the spine.

Either type of manipulation can be effective for back pain, particularly if pain is caused by problems such as sprains (damage to the ligaments) or strains (damage to the muscles).

If osteoporosis, osteoarthritis, rheumatoid arthritis or ankylosing spondylitis weakens your spine, however, your doctor may advise you to stick to osteopathic manipulation, which is generally gentler than chiropractic manipulation.

An added benefit of osteopathic medicine: osteopathic physicians are licensed doctors, just as MDs are. Many specialize in rheumatology and can also prescribe medications and other treatment for underlying cause of your pain.