Minimizing Low Back Pain

The Bottom Line

Over 90% of acute low back strains do not require tests or investigations and will improve after 4 or 5 days and completely clear up after two or three weeks without specific therapy. The most important treatment is to control pain and to continue daily activities. Returning to normal activities even while uncomfortable will shorten the length of the problem by several days and result in a better recovery. During the acute phase use of acetaminophen, NSAIDS, tricyclics, muscle relaxants and heat are beneficial. If the problem continues past two weeks, there is some evidence supporting use of acupuncture, spinal manipulation and intensive physiotherapy.

Signs (red flags) that suggest that an episode of low back pain requires assessment and tests include a previous history of a cancer, recent unexplained weight loss, back pain that gets worse when resting and recent trouble with bowel or bladder control. Further investigation is recommended if the pain radiates from the back down the leg to the ankle or at least below the knee, if there is pain, numbness or weakness in both legs, or if the patient has AIDS or other disease that could suppress the immune system, to rule out spinal infection. Persons using street drugs may require investigations to rule out infections.

Medications with good evidence of short-term effectiveness for low back pain are NSAIDs, acetaminophen, skeletal muscle relaxants (for acute low back pain), and tricyclic antidepressants (for chronic low back pain). Evidence is insufficient to identify one medication as offering a clear overall net advantage because of complex tradeoffs between benefits and harms. Individual patients are likely to differ in how they weigh potential benefits, harms, and costs of various medications.