Your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs. Your doctor might also ask you to rate your pain on a scale of zero to 10 and talk to you about how well you're functioning with your pain.
These assessments help determine where the pain comes from, how much you can move before pain forces you to stop and whether you have muscle spasms. They can also help rule out more-serious causes of back pain.
If there is reason to suspect that a specific condition is causing your back pain, your doctor might order one or more tests:
- X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. These images alone won't show problems with your spinal cord, muscles, nerves or disks.
- MRI or CT scans. These scans generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
- Blood tests. These can help determine whether you have an infection or other condition that might be causing your pain.
- Bone scan. In rare cases, your doctor might use a bone scan to look for bone tumors or compression fractures caused by osteoporosis.
- Nerve studies. Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
Most back pain gets better within a month of home treatment. However, everyone is different, and back pain is a complex condition. For many, the pain doesn't go away for a few months, but only a few have persistent, severe pain.
Over-the-counter pain relievers and the use of heat might be all you need. Bed rest isn't recommended.
Continue your activities as much as you can tolerate. Try light activity, such as walking and activities of daily living. Stop activity that increases pain, but don't avoid activity out of fear of pain. If home treatments aren't working after several weeks, your doctor might suggest stronger medications or other therapies.
Depending on the type of back pain you have, your doctor might recommend the following:
- Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), may help relieve back pain. Take these medications only as directed by your doctor. Overuse can cause serious side effects. If OTC pain relievers don't relieve your pain, your doctor might suggest prescription NSAIDs.
- Muscle relaxants. If mild to moderate back pain doesn't improve with OTC pain relievers, your doctor might also prescribe a muscle relaxant. Muscle relaxants can make you dizzy and sleepy.
- Topical pain relievers. These products deliver pain relieving substances through your skin via creams, salves, ointments or patches.
- Narcotics. Drugs containing opioids, such as oxycodone or hydrocodone, may be used for a short time with close supervision by your doctor. Opioids don't work well for chronic pain, so your prescription will usually provide less than a week's worth of pills.
- Antidepressants. Some types of antidepressants — particularly duloxetine (Cymbalta) and tricyclic antidepressants, such as amitriptyline — have been shown to relieve chronic back pain independent of their effect on depression.
A physical therapist can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help keep pain from returning. Physical therapists will also provide education about how to modify your movements during an episode of back pain to avoid flaring pain symptoms while continuing to be active.
Surgical and other procedures
Procedures used to treat back pain may include:
- Cortisone injections. If other measures don't relieve your pain, and if your pain radiates down your leg, your doctor may inject cortisone — a strong anti-inflammatory drug — plus a numbing medication into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts only a month or two.
- Radiofrequency neurotomy. In this procedure, a fine needle is inserted through your skin so the tip is near the area causing your pain. Radio waves are passed through the needle to damage the nearby nerves, which interferes with the delivery of pain signals to the brain.
- Implanted nerve stimulators. Devices implanted under your skin can deliver electrical impulses to certain nerves to block pain signals.
- Surgery. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. These procedures are usually reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn't responded to other therapy.
A number of alternative treatments might ease symptoms of back pain. Always discuss the benefits and risks with your doctor before starting a new alternative therapy.
- Chiropractic care. A chiropractor manipulates your spine to ease your pain.
- Acupuncture. A practitioner of acupuncture inserts thin sterilized needles into the skin at specific points on the body. A growing body of scientific evidence indicates acupuncture can be helpful in treating back pain.
- Transcutaneous electrical nerve stimulation (TENS). A battery-powered device placed on the skin delivers electrical impulses to the painful area. Studies have shown mixed results as to TENS' effectiveness.
- Massage. If your back pain is caused by tense or overworked muscles, massage might help.
- Yoga. There are several types of yoga, a broad discipline that involves practicing specific postures or poses, breathing exercises, and relaxation techniques. Yoga can stretch and strengthen muscles and improve posture, although you might need to modify some poses if they aggravate your symptoms.