Even for serious cases, intensive treatment and good follow-up care can significantly reduce back pain, restore normal function and mobility, and help reduce recurrences.

Many cases of back pain subside after a few days, with enough improvement to allow the patient to resume normal activities.  Cases requiring attention are usually treated in the following manner – and usually at home as "self care":

• Cessation of all normal and especially strenuous activities
• Simple NSAIDs (non-steroidal anti-inflammatory drugs) for pain relief, such as aspirin, Advil, Alleve or Motrin
• Ice for the first 24 to 28 hours after pain develops, then heat after that
• No more than a day or two of bed rest, if possible, after the onset of pain
• Easy-motion aerobic exercises – walking, riding a stationery bicycle, swimming – as soon as they can be performed without aggravating the condition
• Sleep in the "fetal position" with a pillow between the knees, or facing up with a pillow under the knees

One popular misconception is that bed rest is beneficial.  But doctors have determined that, not only is remaining stationary not beneficial, it can be a cause of, or contribute to, back pain.  Current medical wisdom encourages movement and activity as soon as the patient's pain subsides enough to permit it.

The simple treatment regimen above should do the trick in most cases.  If pain persists, however, it might be time to visit a health care practitioner with a good knowledge of back pain.  The result could be any of the following treatments, all of which are proven to provide at least some relief:

• Physical therapy
• Stronger drug treatment
• Spinal manipulation
• Injections of cortisone or a local anesthetic

There are new treatments designed to remove or neutralize the structure in the back believed to be causing the pain.  They include intradiscal electrothermy (IDET) and radio frequency ablation (RFA).  These treatments entail some risk and have the potential for long-term side effects.  But they may be preferable in some instances, to a traditional surgery.

There are a number of "alternative" treatments that have no significant demonstrated physical benefit in a majority of cases.  But they don't cause any harm either, and might provide some relief at the emotional level.  They include massage, ultrasound, electrical stimulation, acupuncture and other techniques.

Only in the most severe chronic cases will medical professionals recommend the most aggressive treatments, such as surgery. Surgery usually is considered only when:

• Many other non-surgical treatments have been tried and failed
• The surgeon believes the procedure will have a good result
• The patient agrees to an invasive procedure that isn't guaranteed to work
• Everyone's decision is being made rationally and not under stress

The most common surgery for chronic back pain is spinal fusion – basically, turning the painful area of the spine into a solid, immovable piece of bone.  The theory is simple:  If it isn't moving, it shouldn't hurt.  The procedure involves a bone graft or bone substitute to fuse two vertebrae together.  This is a major invasive procedure that can take a year or more to recover from.  But back pain can be greatly reduced unfortunately, it is rarely completely eliminated.

One technique new to the United States – but practiced in Europe for several years – is disc replacement surgery.  It involves removing a degenerated disc and replacing it with an artificial component – similar to knee or hip replacement surgery.  It has the benefits of maintaining flexibility and requiring a shorter recovery time.

Whatever treatment is used, people who recover from back pain should take steps to prevent its recurrence.  People who never have suffered an episode of back pain should take steps to ensure they never do.  Preventative measures include:

• Exercise / stay active
• Lose weight
• Stop smoking
• Get help when lifting a heavy or awkward object
• Lift using your leg muscles, not your back
• Avoid standing for long periods of time  (use a stool, shift from foot to foot)
• Don't wear high heels
• Use cushioned soles when walking
• Use a work chair with a straight back, adjustable seat, back and armrests, and a swivel seat
• Sit with your knees higher than your hips  (use a stool)
• Place a pillow or other lumbar support behind your lower back while sitting or driving
• Break up long drives by stopping often and walking around

Even for serious cases, a combination of proven treatments and good follow-up preventative care can relieve most cases of back pain, restore normal function / mobility, and help reduce recurrences.