last updated 18 Oct 2019

This page was originally written for lower back pain (LBP) and musculoskeletal related pain, but many of the LBP treatments work for a variety of pain causes.

Treatment Procedures:
A wide range of treatment is available for low back pain (LBP), depending on what is causing the pain and how long it lasts. Most people find that their low back pain improves within a few weeks -- A few months for old people like me--. Chances are good that your pain will go away soon with some basic self-care. However if you have one of the symptoms that require immediate attention (diagnosis - surgery) you should see a doctor.

Over half, up to 80%, of people with back pain even from a herniated disc, will recover without surgery. With time most herniated discs will dehydrate and degenerate, absorbing the protruding cartilage.
Your family physician can help you decide whether to wait and see or visit a neurosurgeon or orthopedist for expert diagnosis. They will keep you under observation for muscle weakness, loss of reflexes, and other symptoms indicating as possible need for surgery.

My cousin, a physician who has seen a lot patients with lower back problems, including himself and his father, says "Even 'disproven' treatments help some people whether placebo or not. We all know that treatments with 'proven' benefit do not help many people. Muscle injuries at out age can often take months to heal. If triggered by underlying spinal abnormalities ( arthritis, micro fractures, etc. ) the annoying muscle pains can be recurring. "

There are are a variety of treatments:


Traditional Treatment:
Pain medication, anti-inflammatory drugs, rest, heat/cold and eventually
exercise to prevent further problems is the first choice.
30 tablets of 800mg ibuprofen is about $6-7.
The energy to heat water for a hot bath (60 gal) or a 15-20 min. shower at 2.5 gal/min. is from 50¢ - $1 or about $10 for every other day for 3 weeks.

See relief below:


Alternative/Complementary Therapies

Yoga, Pilates, Swimming


See Alternative/Complementary Therapies
Alternatives to Pain Medications:
CBD (Cannabidiol)
CBD oil-filled capsules 15 mg $40, 30 mg, 30 mg $60

Cannabidiol, commonly referred to as CBD, is a new and relatively understudied treatment for pain,
It is derived from the cannabis sativa plant and hemp.
It is not psychoactive like THC which is also produced from the canabis sativa plant (marijuana), although you can get CBD with THC in various ratios.

It comes in Creams and gels for topical use on the skin.
Oils which can be taken in oil-filled capsules or mixed into beverages.
Tinctures - A more concentrated form administered by the dropper.

You can also get a tincture which includes various ratios of CBD and THC which is available in states which allow marijuana.
These also come in a form which can be vaped. see 10 Things You Need to Know Before Vaping CBD Oil - Vaping360

See :
Understanding CBD (Cannabidiol) for Back Pain
CBD Oil For Medical Conditions: Unregulated, Unproven | AARP Bulletin
64 million Americans have tried CBD. Two-thirds said it helped their health issue all by itself, and 30 percent said CBD helped when combined with conventional medications."
Joseph Maroon, a professor at the University of Pittsburgh Medical Center, says his patients with joint and back pain get relief with over-the-counter CBD. "Any time there's inflammation, CBD may help," he says


Omega-3
Omega-3 EFAs (Essential Fatty Acids) have an anti-inflammatory effect.

What Are Omega-3 Fatty Acids?

Omega-3 fatty acids are found in fatty layers of cold-water fish and shellfish, plant and nut oils, English walnuts, flaxseed, algae oils, and fortified foods. You can also get omega-3s as supplements. Food and supplement sources of these fatty acids differ in the forms and amounts they contain.

There are the two main types of omega-3 fatty acids:

Sources:
Source PRO CON
Flaxseed Oil
Primus capsules
Fish such as salmon or mackerel. Natural Both farmed and wild salmon contain some compounds that are not good for the body. This is because salmon can absorb some chemicals and pollutants through their diet and their environment.
Supplement Capsules Easy Many are not what they claim to be. They are unregulated.
Primus capsules is a food supplement that contributes to normal brain function. With omega-3 fatty acids (EPA and DHA [Docosahexaenoic acid]), magnesium, folic acid, vitamin B12 and vitamin E, it has been specifically formulated to assist as a potentiator of anti-depressant therapy. See:
Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. - PubMed - NCBI

Why not flaxseed oil? - Harvard Health Other Supplements:
I have a friend that was diagnosed with stenosis, who says taking magnesium supplements worked when epidurals, physical therapy and chiropractors did not.
See: Ending Back Pain With the Help of Magnesium from Jigsaw, a manufacturer
and Natural Calm / Magnesium Supplement at HerbsWest.net

There are a variety of medications, supplements for treating osteoporosis


Alternative Therapies Whole-body cryotherapy (WBC):
$200 / month for unlimited sessions. (3/week recommended)
WBC involves going into a -175 to -250° F chamber with only shorts, mittens, socks, beanie and a face mask for 2.5 to 3.5 minutes. Your skin temperature will drop from about 90° to 45° -- mine droped to 40° in 2 minutes.
Benefits supposely include: (A lot of this seems to be marketing hype with no studies to verify it.)
My personal experience at US Cryotherapy in Davis, which had a chamber that varied from -160° to 180° F was 2 minutes dropped my skin temperature from 90 to 40°. See Whole Body Cryotherapy (WBC): A "Cool" Trend that Lacks Evidence, Poses Risks | FDA In recent years, WBC has become rather fashionable, particularly among sportspeople; the frigid temperatures are supposed to improve healing times for sports injuries.

Effect of cryotherapy on the lumbar spine in elderly men with back pain. - PubMed - NCBI says,
"A group of elderly men who participated in WBC showed significantly lower values of active potentials of erector spinae muscles in the lumbar part of the spine and a significant increase in the range of the lumbar spine mobility, in comparison to the group which did not use WBC." Cryotherapy: Can it stop your pain cold? - Harvard Health Blog - Harvard Health Publishing says,
There are no conclusive studies of WBC effectiveness.

The following conditions are contraindications to Whole Body Cryotherapy: Pregnancy, severe Hypertension (BP> 180/100), acute or recent myocardial infarction, unstable angina pectoris, arrhythmia, symptomatic cardiovascular disease, cardiac pacemaker, peripheral arterial occlusive disease, venous thrombosis, acute or recent cerebrovascular accident, uncontrolled seizures, severe Raynaud's Syndrome, fever, tumor disease, symptomatic lung disorders, bleeding disorders, severe anemia, infection, cold-allergy, acute kidney and urinary tract diseases.


Acupuncture:
$450 - $75/session - 2 sessions per week for 3 weeks (average)
In eastern tradition acupuncture is thought to correct imbalances in the flow of energy in the body, called qi (pronounced "chee").In Western scientific terms acupuncture is thought to ease pain by affecting neurotransmitters, hormone levels, or the immune system. See Acupuncture.

Plan on weekly treatments until you start to see a benefit, then gradually lengthen the time until the next visit.

CMS Proposes to cover Acupuncture for Chronic Low Back Pain for Medicare beneficiaries enrolled in approved studies | CMS, July 2019
The Centers for Medicare & Medicaid Services (CMS) proposed to cover acupuncture for Medicare patients with chronic low back pain who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies.

Acupuncture | WebMD says "One recent review of 22 acupuncture studies showed that it provided short-term relief from chronic back pain. Those studies also found that, compared to standard treatment, both actual acupuncture and sham acupuncture are more effective."
Acupuncture is worth a try for chronic pain - Harvard Health Blog - Harvard Health Publishing, 2013:
An international team team pooled the results of 29 studies involving nearly 18,000 participants. Some had acupuncture, some had "sham" acupuncture, and some didn't have acupuncture at all. Overall, acupuncture relieved pain by about 50%.
A 2016 Guardian article "Acupuncture for low back pain no longer recommended for NHS (National Health Service) patients"
Professor Mark Baker, clinical practice director for Nice (National Institute for Health and Care Excellence), said: "There is not enough evidence to show that acupuncture is more effective than sham treatment."


Red Light Therapy:
Red 660nm and Near Infrared (NIR) 850nm light.
Red and near infrared wavelengths of natural light stimulate the mitochondria in your cells, the powerhouses responsible for taking light, oxygen, and the food we eat--and turning it into usable energy for our bodies through the process of cellular respiration using Adenosine triphosphate (ATP), energy-carrying molecules.

It is used for skin health, collagen production, physical performance & muscle recovery, sleep, joint pain, inflammation, and more.

There are several companies producing these: JOOVV has a wide selection of devices in a variety of sizes, light output, ... devices
NovoTHOR porduces a whole body device like a tanning bed.
Hooga also has a variety of smaller devices.

There are home led lights from $40 - $160. See Amazon.com: joovv red light therapy


Physical therapy consists of deep heat (delivered as high-frequency sound waves), deep massage and active exercise. They may also use Transcutaneous Electrical Nerve Stimulation (TENS) is also known as E Stim, which sends a painless electrical current to specific nerves. The current may be delivered intermittently. The mild electrical current generates heat that serves to relieve stiffness, improve mobility, and relieve pain. The treatment is believed to stimulate the body's production of endorphins or natural pain killers.
Extended bed rest is no longer the preferred treatment:
Studies have shown that bed rest of any duration is not an effective therapy for Lower Back Pain (LBP) and that it often delays recovery. Sciatica, even when due to nerve-root compression, is not improved with bed rest either. Detrimental results of prolonged bed rest include losses in muscle protein and bone calcium, lumbar muscle atrophy, and undesirable psychologic effects. Several current guidelines advise no more than 2 days of rest for patients with acute LBP.
Source: Sports Medicine Approach to Low Back Pain: Bed Rest or Early Activity?, 2002, at Medscape Today.
See also: Bed rest for acute low-back pain and sciatica. , 2004, National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM) in the National Institutes of Health (NIH).

A 2003 study of the "Journal of Bone and Joint Surgery" 85:975 (2003) compared 278 patients aged 18 to 65 years of age (mean age, 44 years; 53% women) with acute low-back pain or a recent episode (<72 hours) of chronic low-back pain (LBP) with spontaneous lumbar pain. Bed rest and normal daily activity were equivalent for recovery.


In Consumer Reports May 2017 article "Home Remedies for Back Pain: What Really Works" they report the following results from their survey:

Beating Back Pain | Consumer Reports Video


Chiropractors:

Chiropractors are another option that have helped many people, but they cannot diagnose or treat problems which require surgery.

For many years, chiropractors were labeled as quacks by the established medical community. Only in recent years have medical doctors started to work with chiropractors.
In the Consumer Reports reader survey below chiropractic had the best patient satisfaction.
According to Chiropractic Versus The AMA in EZineArticles.com: "There is no scientific evidence that supports chiropractic theories; All the studies made in support of chiropractic are basically testimonials from patients."
One friend suffered a burst disk after a chiropractor session.

See: The Chiropractic page for more information.

In a 2009 article "Relief for your aching back: What worked for our readers" (Article is no longer available) by Consumer Reports they found the percentage of people highly (completely or very) satisfied with their back-pain treatments and advice varied by practitioner visited and type of treatment.
Professional Highly
satisfied
Chiropractor D.C. 59%
Physical therapist 55%
Acupuncturist 53%
Physician (DO or MD), specialist 44%
Physician, primary-care doctor 34%
Treatment Type Beneficial or
Very helpful
Chiropractic treatments 58 %
Spinal injections 51%
Massage 48 %
Physical therapy 46 %
Prescription medications 45 %
Over-the-counter medication 22 %

Pain Relief | How to Get Relief from Chronic Pain - Consumer Reports 2019

Don't seek chiropractic adjustment if you have osteoporosis or signs or symptoms of nerve damage, such as numbness, tingling or loss of strength in an arm or leg.


Stress Reduction - Mindfulness

If you believe Dr. Sarno's 1990 best selling book "Healing Back Pain: The Mind-Body Connection", the majority of back pain is psychosomatic caused by stress. i.e. the adult version of children's stomach ache. See stress reduction below.

There is increasing evidence that regular mindfulness practice reduces a person's pain experience. In 2015, Fadel Zeidan, Ph.D., and his colleagues conducted a study to investigate the effectiveness of mindfulness practice in pain management. Brain images of participants who received mindfulness as treatment had less activation in the parts of their brains that manage pain messages.
Source: Use mindfulness to cope with chronic pain - Mayo Clinic Health System


Medication:
Anesthetic injections:

Neurogenic Pain: Can be treated with Epidural Steroid Injections with or without lidocane, narcotics or tranquilizer type substances.
Other injections: Selective nerve root block (SNRB), Facet joint block, Sacroiliac Joint Injections.

See: Guide to spinal injections

Radiofrequency ablation (or RFA) uses radio waves to heat up a small area of nerve tissue, destroying the nerves ability to transmit pain signals. It is frequently used for arthritic or inflames facet joints which can cause chronic pain radiating to the buttocks or back of the leg.

Typically muscle relaxants and pain medication are used for short episodes of acute back pain. See Relief and Prevention below.


Do it yourself devices:
Inversion Table:
Allows you to hang upside down or partially inverted for 5-10 minutes twice a day or 10-15 minutes before bed to relieve pressure on discs. In addition to relieving back pain they claim improved sleep, mental alertness, flexibility and posture. They cost $200-400.
You can increase the effect and get an additional workout by lifting weights while inverted.

It is based on the principal that when you invert your body, the amount of weight pulling on each level of your spine is directly proportional to the amount of force needed to produce proper alignment.

Here's how it works: The weight of your head exerts just the right amount of pull for your cervical spine. The weight of your head, neck, chest, shoulders and arms is exactly the right amount of combined weight needed for the thoracic spine. The same goes for the lumbar spine: See: Do Inversion Tables Really Work? at LoseTheBackPain.com
Spinal Decompression Treatment for Lower Back Pain and Sciatica
and www.inversion-table-direct.com/


Other Home Remedies:
See: Ice, heat and medication in Relief below
and Home Remedies for Back Pain

Other conservative treatments are listed under Relief and Prevention below.


Relief - Prevention

Relief:

Prevention:
See: Yahoo! Health

Stress Reduction:
According to an article in the January 2007 issue of Health Psychology. Biofeedback or cognitive-behavioral therapy (CBT) can actually reduce feelings of pain by about 30 percent, in patients with chronic back pain.
"That approach teaches patients to divert their attention from pain and to think about it in a less alarming manner. For instance, pain often triggers waves of fear because we associate a sudden twinge with damage to bone, muscle, or skin."
The senior author of the study, Robert Kerns, a psychologist at the Veterans Administration Connecticut Healthcare System and a professor at Yale University says. "Now it's clear these therapies affect the intensity of the pain itself."
See: U.S.News article "Psychological Treatments Are a Balm for Back Pain"


Links:
Welcome to the UC Davis Center for Advancing Pain Relief (CAPR)
Pain and the Older Adult - an Interprofessional Learning Module for Prelicensure Health Professional Students | UC Davis Health
Pain and the Older Adult - Healthcare Provider - Patient Interacton | UC Davis Health YouTube