Recommended Treatments for Low Back Pain

• Updated on: 2018-11-15
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Over any 3-month period about 25% of Americans will have low back pain. It is the top cause of disability around the world.

Unfortunately, even though low back pain is common, treatment for low back pain often fails to reflect evidence-based guidelines, leading to overtreatment—including unnecessary surgery or opioid prescription.

So what are the best approaches for back pain?

In March 2018, The Lancet noted that the guidelines are evolving: now there is "less emphasis on pharmacological and surgical treatments" and greater emphasis on "self-management, physical and psychological therapies, and some form of complementary medicine."

If you experience back pain not related to an acute injury, here's what you should consider:

Movement (including exercise and physical therapy) Remaining active is usually preferable to rest and inactivity. Physical therapists are movement experts who can prescribe exercise programs to meet individual goals and needs. Education Understanding pain and getting tips to self-manage pain can be beneficial for any kind of chronic pain. Cognitive behavioral therapy This can be beneficial for any kind of chronic pain. Yoga Since yoga involves movement, it may be beneficial, though it should be combined with recommended treatments. Massage Some patients feel short-term relief, but active movement-based therapy is more beneficial long term. This should be combined with recommended treatments. Acupuncture Some patients feel short-term relief, but active movement-based therapy is more beneficial long term. This should be combined with recommended treatments. Spinal Manipulation Some patients feel short-term relief that can improve function. This should be combined with other recommend treatments, particularly exercise and active treatments. Opioids The Centers for Disease Control and Prevention guidelines recommend opioids for chronic pain only after lower risk treatments have been tried, and then only when dosed appropriately and combined with nonopioid treatments. Heat Some patients feel short-term relief, but there is limited evidence to suggest significant long-term benefits. This should be combined with recommended treatments. Imaging scans (such as x-rays and MRIs) Imaging is not recommended for routine treatment of low back pain and often leads to unnecessary treatment. Spinal injections Injections do not appear to provide long-term benefits or reduce the likelihood of surgery. Surgery Surgery is not recommended for most back pain. Bed rest Bed rest and other inactivity can make back pain worse.

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.

The following articles provide some of the best scientific evidence related to treatment of low back pain.

Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs (Health Services Research, May 2018)

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians (Annals of Internal Medicine, April 2017)

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (Centers for Disease Control and Prevention, March 2016)

Five Things Physical Therapists and Patients Should Question (Choosing Wisely, November 2015)

Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association (Journal of Orthopaedic and Sports Physical Therapy, April 2012)