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Nonsurgical Treatments for Chronic Back Pain

Please note that it's always a good idea to consult with your personal doctor before starting any new exercise regimen or lifestyle change.

  1. Physical Therapy and Home Exercise Program Exercise is the foundation of chronic back pain treatment. It’s one of the first treatments you should try, under the guidance of your physician and spine physical therapist. However, one set of exercises does not work for everyone, says Van. Prescribed exercises can and should be tailored to your specific symptoms, condition and comfort level. Maintaining your exercise routine regularly at home is even more important than the work you do during the physical therapy — a consistent regimen is the key to maintaining the spine’s strength and stability. Physical therapy for chronic back pain may include:

  • Core strengthening

  • Stretching and flexibility exercises

  • Retraining posture

  • Testing the limits of pain tolerance

  • Aerobic exercises at a comfortable pace

  1. Mindfulness and Meditation Chronic back pain is both physically and emotionally straining. To manage the frustration, irritability, depression and other psychological aspects of dealing with chronic pain, you may get referred to a rehabilitation psychologist. This specialist may recommend meditation, yoga, tai chi and other cognitive and relaxation strategies to boost your conscious control over your nervous system and its response to activity.  

  2. Diet Change Some diets are highly inflammatory, especially those high in trans fats, refined sugars and processed foods. Consult with your doctor to see if your diet could be contributing to your chronic back pain and how you could change it. Maintaining a healthy weight could also help lessen back pain by reducing pressure on your spine. Referral to a nutrition specialist is the best way to get personalized advice for strategies to access more balanced foods and to develop eating habits that support your health goals.

  3. Lifestyle Modifications There are many ways to adapt and adjust your behavior and activity that can significantly improve chronic back pain before even considering medications or procedures. “Listen to your body and learn to pace yourself,” suggests Van. Take breaks when doing strenuous chores, and make several trips or ask for help when carrying heavy or multiple objects such as groceries. Take note of the activities that worsen your pain and avoid them, if possible, while engaging more with activities you find comfortable and enjoyable. Not only could this help your back feel better, but it may also prevent the underlying condition from advancing. It’s also important to consider minimizing harmful habits like smoking, which is proved to heighten pain and delay healing. Focus on one realistic goal that you can achieve comfortably and consistently before addressing another lifestyle change. 

  4. Injection-based Treatments Trigger point injections, epidural steroid injections, nerve blocks, nerve ablations and other types of injection-based procedures are available for chronic back pain. These procedures are considered when the source of the pain is known, and they can sometimes help rule out certain causes if the treatment does not work. Injections may stop or lessen pain for a while, but they are not intended as long-term solutions and shouldn’t be used in isolation. The goal of injection-based treatments is to improve pain control and maximize your participation in regular gentle activity such as physical therapy and home exercises.

  5. Alternative Treatments Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other nonsurgical spine treatments can make a difference for chronic back pain. Overall, the potential benefits of these strategies far outweigh their potential risks, so they are worth exploring. Talk to your spine specialist about alternative treatments that could help you.

  6. Pharmacologic Treatments All kinds of medicines (topical, oral, injectable) are used to help manage chronic back pain, including anti-inflammatories, muscle relaxants, nerve pain medications and even antidepressants. However, any medication can have unwanted side effects. Work with your doctor to explore medication strategies that directly address the cause of your pain (if it is known). Find the lowest effective dose to minimize side effects, and use medications only for as long as they are helpful and well-tolerated. “Opioid medications are not recommended as a first-line strategy for chronic back pain,” Van says. “They are most helpful in the short term for acute pain, like after a traumatic accident or surgery, because they act to shut down pain signaling temporarily without addressing a root cause of pain, like inflammation. Past the expected healing period, opioids should be phased out and nonopioid medications should be maximized to achieve pain control long term. Prolonged use of opioids is so stigmatized because it inevitably leads to medication tolerance, escalating to higher and riskier doses, physical dependence and habit formation.” Opioids should be prescribed only after first-line and second-line pain medications have been tried without providing relief. If you find yourself relying on opioids to get through the day and you have not been offered many alternatives, it may be time to seek a second opinion.


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