LONDON, March 22: Millions of people experience lower back pain, whether short-term or chronic, with 60% of UK adults likely to suffer from it at some point in their lives. However, knowing how to effectively manage the pain can be challenging, especially with recent global reviews suggesting that most available treatments have limited effectiveness. Despite this, there are several treatments endorsed by medical bodies like the National Institute for Health and Care Excellence (NICE) and the NHS that can help alleviate symptoms.

Exercise: Exercise is widely regarded as an essential first step in managing lower back pain. According to NICE, various forms of exercise—such as stretching, strengthening, aerobic workouts, and yoga—are beneficial for relieving back pain. NHS England concurs, recommending individuals to “try doing some exercises and stretches for back pain.”

A global review, published in BMJ Evidence-Based Medicine, also highlighted exercise as one of the five most effective methods for tackling chronic lower back pain. The Chartered Society of Physiotherapists further supports this, noting that “exercise has been shown to be the most helpful treatment for back pain.” Although hands-on treatments offer some benefit, they are most effective when combined with exercise as part of a broader treatment plan. NICE and the NHS recommend that individuals continue with their normal activities as much as possible.

Medication: Medications can be effective, but it’s essential to choose the right one. While paracetamol was once commonly recommended for back pain, current guidelines suggest that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin should be used instead. NICE and NHS England advise taking anti-inflammatory medicine like ibuprofen, noting that paracetamol alone is not recommended for back pain, though it can be combined with other painkillers.

The global review of treatments found that NSAIDs were the most effective option for addressing acute lower back pain. NICE further states that weak opioids, such as codeine, should only be considered for acute back pain when NSAIDs are ineffective or unsuitable.

Physiotherapy: Physiotherapy is another common recommendation for those suffering from lower back pain. Many patients are referred by family doctors to physiotherapists for assessment and exercises, according to Prof. Kamila Hawthorne, chair of the Royal College of General Practitioners. For patients with more chronic pain, non-medical interventions from link workers may be suggested. The global review noted that many patients experience relief from both medical and non-medical treatments.

However, NICE advises that treatments such as massage and manipulation by therapists should only be used alongside exercise, as there is insufficient evidence to support their standalone effectiveness.

Psychological or talking therapy: For individuals whose pain persists despite other treatments, NICE recommends combining physical treatments with psychological therapies, such as cognitive behavioral therapy (CBT). This approach is particularly beneficial for those with significant psychological and social barriers to recovery.

Heat and cold: Heat and cold therapies can also help relieve back pain. NHS England suggests using an ice pack or a bag of frozen peas wrapped in a tea towel to reduce pain and swelling. Alternatively, a heat pack or hot-water bottle wrapped in a tea towel can help relieve joint stiffness and muscle spasms.

Overall, while the global review highlighted limited effectiveness of many back pain treatments, exercise, medication, physiotherapy, psychological therapy, and heat and cold treatments are still considered valuable options for managing lower back pain effectively.