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Which therapy is best for back pain

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Back pain is considered chronic if it lasts three months or longer. It cancome and go, often bringing temporary relief, followed by frustration.Dealing with chronic back pain can be especially trying if you don’t knowthe cause.

Back pain rehabilitationspecialistAndrew Nava, M.D., offers insights into common chronic back pain causes and nonsurgicaltreatment options—and advises not to give up hope.

Common Causes of Chronic Back Pain

Chronic back painis usually age-related, but can also result from a prior injury. The mostcommon causes include:

  • Arthritis of the spine —the gradual thinning of the cartilage inside the spine
  • Spinal stenosis —narrowing of the spinal canal that may lead to nerve pain
  • Disc problems, such as a herniated or bulging disc
  • Myofascial pain syndrome—unexplained muscle pain and tenderness

In some cases, it’s difficult to pinpoint the cause of chronic back pain.“If your doctor has exhausted all diagnostic options, it’s time to seek asecond opinion from a back pain specialist,” recommends Nava. It’simportant not to make rushed decisions or undergo extensive medicalprocedures until the origin of the pain is found. Not only may they nothelp; they could make the pain worse, warns Nava.

If the source of the pain is not known or can’t be treated, your bestoption may be to work with your doctor on reducing the flare-ups and makingthe pain manageable with nonsurgical treatments.

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Chronic or long-term back pain can be challenging for doctors to treat. However, it is possible to treat back pain without surgery, such as having spinal manipulation, acupuncture, and making lifestyle changes.

Back pain is a widespread problem, with low back pain affecting an estimated 80% of adults at some point in their lives. The pain may develop suddenly as a result of a muscle strain caused by heavy lifting or an accident. Other times, conditions such as arthritis, osteoporosis, or scoliosis can cause back pain.

Sometimes, and depending on the cause, doctors may recommend surgery to treat chronic back pain.

However, surgery is not always necessary. Other treatment options that can improve or relieve back pain include home remedies, alternative medicine, and lifestyle changes. A person may wish to try these options before deciding on surgery.

Back pain has many different causes and varies in severity. There is no single treatment that works for everyone. This article explores the evidence behind 11 nonsurgical treatments for back pain.

1. Spinal manipulation

A therapist treating back pain without surgery.

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Spinal manipulation is one way to manage back pain without surgery.

Spinal manipulation, or chiropractic manipulation, involves using the hands to adjust, massage, or stimulate the spine.

The National Center for Complementary and Integrative Health (NCCIH) state that a some studies have shown that spinal manipulation may help with low back pain.

However, spinal manipulation is not safe for everyone, including people who have osteoporosis, arthritis, or spinal cord problems.

Only a trained and licensed provider should perform these treatments. People who can perform these techniques include:

  • licensed chiropractors
  • physical therapists
  • osteopathic doctors
  • some medical doctors

When a trained specialist performs spinal manipulation, serious side effects are rare. Any minor side effects, such as discomfort in the area, will usually resolve within 1–2 days.

2. Acupuncture

Acupuncture is a Traditional Chinese Medicine practice. An acupuncture practitioner inserts thin needles into specific points on the body. People use acupuncture for a variety of ailments, from chronic diseases to chronic pain.

An overview of systematic reviews states that acupuncture may help restore function and relieve pain in some people who have chronic low back pain. A meta-analysis also found that acupuncture provides relief for chronic pain that may continue to work well over time.

3. Weight loss

The back muscles, bones, and joints work hard to support the body as a person moves, sits, and stands. Being overweight can cause back pain due to increased pressure on the spine and strain of the back muscles. One study found that obesity has links to high levels of low back pain and disability in men.

Losing weight could help alleviate some or all of a person’s back pain if weight is a contributing factor. If a person is overweight, they may wish to work with their doctor to find ways to lose weight.

4. Anti-inflammatory diet

Studies have shown that higher levels of inflammation have a close connection to certain types of chronic pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, work well for some types of pain.

Inflammation has many causes. One way to help lower inflammation in the body is to follow an anti-inflammatory diet.

Evidence suggests that some foods, especially sugary and processed foods, can make inflammation worse. Research suggests that certain foods can help lower inflammation in the body, including:

  • vegetables
  • fruits
  • nuts
  • fish
  • whole grains

Similarly, studies show that processed foods and sugar can promote inflammation, which could make the pain worse. People with back pain may wish to try focusing on whole foods and avoiding processed foods, trans fats, and sugar.

6. Exercise

Although a person may find being active difficult when they are living with pain, movement is one of the best natural treatments for many types of pain.

Studies have long supported the fact that exercise can release endorphins. These natural brain chemicals help stop pain by binding to opioid receptors in the brain. This has a mild effect similar to opioid pain medications.

Research suggests that exercises that strengthen the back and neck muscles can reduce pain in people with chronic back and neck pain.

Read about back-strengthening exercises here.

7. Transcutaneous electrical nerve stimulation

Transcutaneous electrical nerve stimulation (TENS) involves a person placing sticky electrode patches onto their back. When a person activates the battery-powered device, it sends electrical impulses to the electrodes, which can interrupt pain signals.

One study found that a 15-minute TENS session provided significant relief from low back pain. A meta-analysis found that TENS provided “significant pain reduction” for people with chronic low back pain.

A person may purchase a TENS device from their doctor or online.

8. Stress management techniques

Stress can cause a person to tense their muscles, which can cause back pain or make existing back pain worse. The American Institute of Stress lists back pain among the symptoms of stress. One study also explains that stress can cause changes in the body’s perception of pain.

People who experience high levels of stress may wish to try methods that can help with relaxation and stress relief, including social support, meditation, and exercise.

Wearing the wrong type of footwear can cause the legs, hips, and back to misalign. This misalignment can lead to back pain. High heels, shoes that are too tight, or shoes that offer poor support are possible back pain culprits.

One study found that people who wore custom orthotics in their shoes for 6 weeks saw a significant improvement of back pain.

Speak to a foot specialist about whether wearing orthotics could help.

10. Physical therapy

Physical therapy involves doing specific stretches and exercises under the guidance of a licensed physical therapist. These exercises may relieve tension or strengthen specific areas to help relieve pain.

A large study found that people who used physical therapy for low back pain were less likely to need other health care services for their pain later.

11. CBD oil

Cannabinoids are substances derived from the cannabis plant. The two best-known cannabinoids are cannabidiol (CBD) and tetrahydrocannabinol (THC).

THC is commonly found in marijuana and is the chemical responsible for the feeling of a “high.” CBD oil is often derived from the hemp plant and does not cause this sensation.

People use CBD oil to treat a variety of ailments, including pain. A systematic review found that cannabinoids provided a significant effect on pain reduction. However, researchers need to do more studies before experts can recommend CBD oil as an effective pain reliever.

CBD oil is not legal in all states. A person should check their local laws before purchasing or using it.

When is surgery appropriate for back pain?

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A doctor may suggest surgery if home remedies, medication, and noninvasive treatments have not been effective.

Although back pain affects many thousands of people, doctors do not follow a set “standard” for deciding whether surgery is necessary for back pain. If home remedies, medication, and noninvasive treatments have not helped, and back pain is interfering with life, a person may wish to discuss surgical options with their doctor.

Surgery does not necessarily correct all types of back pain. It can help with back pain that is caused by particular physical issues in the spine. It may help people who have a bone spur, a bulging or ruptured disk, a spinal issue, or a nerve that is under pressure.

If other issues are causing back pain, surgery may not be an appropriate treatment.


Often, back pain is a result of a minor injury or overuse of the back muscles. This will usually get better over time and heal faster with treatment. If a person has back pain as well as other symptoms, such as fever, numbness, foot drop, or if it occurs after an accident, see a doctor.

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