Health
What really works for back pain (hint: it’s not bed rest)
About 1 in 6 people experience lower back pain at some point in their lives and the best ways to treat it are surprising.
By Paula Goodyer
Back pain is one of the most common reasons to see a doctor, but the strategy of managing it has changed, and it’s got little to do with opioid painkillers, spinal fusion surgery, spinal stimulation, and definitely not bed rest.
“We know now that there’s little if any benefit from expensive treatments like spinal stimulation and spinal fusion, and that the benefits of opioid painkillers are much less than previously thought,” says Professor Chris Maher, Director of the Institute for Musculoskeletal Health. His 2023 research with colleagues from the University of Sydney found that oxycodone was no more effective than a placebo – despite being widely prescribed for back pain.
What causes lower back pain?
There are 4 general categories, says Professor Maher.
- Non-specific back pain (the kind most people have) is a mix of causes, often unknown, but can include sprained or strained ligaments or muscles. Around half of people in this category recover in 2 to 3 weeks
- Pain from conditions affecting the nerves in the back, often called ‘sciatica’.
- Pain from a condition unrelated to the spine – like a urinary tract infection (UTI), but you’d probably have other symptoms too.
- Pain from a spinal condition needing prompt treatment like cancer, fracture or an infection such as an infected disc – but these aren’t common causes.
Are X-rays or CT scans necessary?
Unless your GP needs to rule out a serious problem like a fracture or cancer, there’s usually no need for imaging.
“You’re better off saving the money to use on treatment from a physiotherapist or exercise physiologist,” he says.
What actually works to treat it?
- Movement and exercise, but not bed rest, says a major new review of the evidence covering 97,000 people with low back pain- a problem affecting one in six of us at some time in our lives.
- A team approach from a doctor, physiotherapist and psychologist could also help with pain lingering beyond six weeks - a psychological approach involving education about pain, plus Cognitive Behaviour Therapy (CBT) to help change how we think about pain, can help reduce it.
- Acupuncture might help, although it’s not clear how it works. But traction – stretching the spine using pulleys or weights – probably doesn’t work, and the benefits of spinal manipulation are uncertain. With treatments like back braces, vibrating massage guns or herbal patches, there’s not enough research to know whether or not they’re useful.
Movement is your back’s best friend
“There’s good evidence that an exercise program prescribed by a physiotherapist or exercise physiologist can improve back pain, and that regular exercise can halve the risk of back pain recurring,” says Chris Maher. “Studies have also found that a mix of strength, cardio and flexibility exercise can also prevent lower back pain from occurring in the first place.”
All the more reason to mix up your exercise routine. Start with a little bit per day.
Common misconception: your back is fragile
“It’s a myth that our backs are fragile and that we should shield them from stress,” he adds. “Our bodies thrive on movement, and tissues like muscles, bone and ligaments need movement and loading to keep them strong and healthy, yet people think they need to wrap their backs in cotton wool.”
Even the usual rules about lifting – bend your knees, keep your back straight – don’t have good evidence to back them up, he adds.
“The best advice is to keep the load close to your body as you lift and be especially careful with unstable loads like a child or an animal.”
Do any painkillers help back pain?
Non-steroidal anti-inflammatories (NSAIDs) either as a tablet or a cream seem to be the best medication for short term use.
“But ask your doctor or pharmacist first,” he says. “NSAIDS, while generally safe, can have side effects in some people.”
Making other healthy habits a priority can help too
Treating back pain should go beyond focusing on the back alone, stresses Associate Professor Chris Williams from the University of Sydney whose new research found that adding support from physiotherapists, dietitians and health coaches can reduce disability from back pain and improve quality of life.
“Poor sleep, for example, can predispose us to back pain. It affects the nervous and immune systems - and both are critical to how we experience and regulate pain. It may also increase inflammation in our bodies, impact our mood, how we engage in physical activity and our nutrition - all of which can contribute to back pain. Factors like smoking, alcohol, obesity and unhealthy diets can all contribute to our physical function,” he says. “We find that when we empower people to take control and improve their lifestyle, they do better.”
Like Chris Maher, he also thinks it’s time to change how we think about our backs even though we might be in pain. “Instead of talking about a ‘busted’ back, let’s remind ourselves that our backs are strong,” he says.
Feature image: iStock/Fabio Camandona
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