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What is the best kind of treatment for back pain? Recommendations based on science

Verfasst von Theresia Lechner
Experten Leitlinie Rückenschmerzen

The following situation may sound familiar: you have acute or reoccurring back pain. For this reason, you visit two different orthopaedists. As 85% of back pain is non-specific [1], it is most unlikely you will find a real cause for your back pain. Nonetheless, you – of course – receive two different recommendations about what you should do about the pain. Your neighbour, best friend and Dr Google then also proffer their own expert tips. And the array of treatment options is vast: acupuncture, physiotherapy, operations, and so on and so forth. Do you now no longer know what is actually true and which back pain treatment might be able to help you?

This article gives you clear recommendations on the type of back pain treatment that really helps, and also what is proven to help or not. For this we refer to the German and Austrian guidelines for non-specific back pain. These guidelines are compiled by a large team of experts, comprising physicians, physiotherapists, psychotherapists and scientists. So these are recommendations on which you can rely.

Medikamente gibt es viele und mehrere Wege sind möglich
There are dozens of medicines to relieve back pain. All the more important to know which ones really help

What type of back pain do I have?

Before we delve into the recommendations, here is a short list to help you identify the type(s) of back pain you suffer from. Because, depending on how long it lasts for, back pain is categorised into different types [2]:

  • Acute back pain = duration of pain 1-4 weeks
  • Acute reoccurring back pain = if a new episode of back pain occurs after 6 months of no symptoms
  • Sub-acute back pain = duration of pain 5-12 weeks
  • Chronic back pain = duration of pain >12 weeks or constantly reoccurring back pain within a 6-month period
  • Chronic reoccurring back pain = if a new episode of back pain occurs again within a year after being symptom free

It is important to know that these time periods are more of a rough indication and that there can be a fine overlap between the various stages. This is particularly the case for the overlap between acute/sub-acute back pain and chronic back pain. It varies greatly between individuals and depends on several factors [2].

In this article I will provide some recommendations for acute and sub-acute back pain, i.e. the first three types. When it comes to the right treatment for back pain, it is very important to distinguish between chronic and acute back pain. This is because these two types of back pain have to be treated, in part, very differently [1,2].

If you see your doctor about acute back pain, the first step should be to inspect you for relevant signs of a serious underlying condition (See “Back up your knowledge” box in this article ). If you aren’t showing any such signs, you don’t need to have an MRI/X-ray or to have blood tests done. Rather, it is much more important for your GP to ask in-depth questions about your pain (and your current life situation) and conduct a thorough physical examination. Your GP should also take the time to answer all of your questions, so that you feel well-informed [1,2].

Die Therapie gegen Rückenschmerzen richtet sich nach dem Schmerztyp, der in diesem Diagramm ermittelt werden kann
To find the right treatment against back pain for you, you can use this table to work out what type of back pain you have

Movement, heat and so on: what kind of treatment against back pain actually works?

We’ll start with the recommended non-drug treatment methods. These measures have been ordered by recommendation level. This means that the things listed at the top have the highest level of recommendationfor acuteand non-specific back pain [1]:

  • Active exercise
  • Heat applications, especially in conjunction with movement therapy and exercises
  • Joining a rehabilitation sports group (especially if your back pain is preventing you from going to work or carrying out everyday activities any more)
  • Behavioural therapy with a psychotherapist (especially if you are also currently dealing with mental stress or social problems, such as anxiety or relationship stress)

As well as the above-mentioned points, you can also see a physiotherapist (the most effective treatments are targeted mobilisation and manipulation of the spine). A back massage could also help, although only if in conjunction with active exercises. If you have already tried a lot of treatments without success, another option is to try to reduce your pain with acupuncture treatment or progressive muscle relaxation.

Wärmeflasche und Sportschuhe als Alternative zu Medikamente gegen Rückenschmerzen
Heat combined with exercise, movement therapy or exercise therapy are good treatments for back pain

Bed rest, Kinesio tape and so on: what kind of treatment doesn’t help against back pain?

By now you know what can help you if you have acute back pain. But because you are bound to receive a lot of other fantastic-sounding treatment offers, it is also important to know what DOESN’T help relieve back pain. The following list contains all of the types of treatments available that the guidelines discourage. These include any measures which, to date, haven’t been proven to have any positive effect on back pain [1,2]:

  • Bed rest
  • Kinesio taping
  • Medical aids(back braces and shoe inserts)
  • Magnetic field therapy
  • Percutaneous electrical nerve stimulation (PENS)
  • Cold therapy
  • Traction on equipment
  • Laser therapy
  • Massage (if not in conjunction with active exercises)
  • TENS (transcutaneous electrical nerve stimulation)
  • Therapeutic ultrasound
  • Ergotherapy
Kinesiotape gegen Rückenschmerzen
Although having Kinesio tape stuck to your back may look good, its effectiveness against back pain is yet to be proven

What you have learnt about the best treatment for back pain

You now know that exercise combined with heat is an effective treatment against acute and non-specific back pain. So make sure that you keep moving, both at home and at work. Setting yourself regular reminders to move about can help you sit more actively, for example.

Furthermore, you now know that there are also a lot of forms of treatment that don’t have any effect – or the effect hasn’t yet been proven; Kinesio taping or massages, for example. You can discover even more tips and tricks against acute back pain in this article. I have also compiled a list of various medicines for you, which may help you relieve your back pain.

Back up your knowledge

Operation-based methods are not suitable for treating acute, non-specific back pain. Back operations should only be carried out – if at all – when there is a specific cause, which over 80% of the time is not the case.

Degenerative changes like slipped discs or joint wear – which are entirely normal at a certain age – do not automatically mean you need an operation. Often it is a matter of incidental findings, which are not the cause of your pain [1].

Important to note:
This article contains general recommendations only and must not be used for self-diagnosing or self-treatment. It is not a replacement for visiting your GP.