This is an excellent resource for managing chronic back pain.
Here are the key points:
1) Exercise with the aim of increasing strength and flexibility. Strong core and back muscles help offload the joints and improve posture. Stretching exercises help reduce stress on muscles and ligaments. In order to properly exercise, it is important to pay attention to pacing and to learn the difference between hurt vs harm. Not all exercises work on all people. It is important to tailor specific exercises to the individual. This is why it is important to seek advice from a professional such as a physiotherapist.
A good physiotherapist will focus on movement rather than passive modalities. If you are going to a physiotherapist and spending most of your time on a stretcher without exercising, then you need to find someone else. Passive modalities are not nearly as helpful as active exercise. If you are unable to get professional advice then check this out for tips on exercising at home.
2) Manual techniques. Manipulation of affected areas by applying force to the joints may be of benefit. This is usually done through a chiropractor or osteopath. The evidence for these treatments are mixed while the evidence for exercise is quite strong. In my opinion, I would not discourage a patient from pursuing these treatments because they are generally safe. If after 5 or so treatments you are not noticing any benefit then it is unlikely that additional treatments will start to produce results. In my own practice, I have seen some patients swear by their chiropractor or osteopath and I have seen others who have not benefited. This could be said for any treatment in medicine which helps some but not others.
3) Managing the mind. Stress, depression, anxiety etc, play an important role in influencing pain. Although I never believe that ‘pain is in your head’, I believe that your mind can both increase or decrease your pain.
4) Superficial heating or cooling. While hot packs or cold packs can offer temporary relief, they will not permanently improve the underlying cause of pain. Some patients may have heard that cool packs will settle inflammation in the back leading to long term relief. This has not been proven to be true. Warm packs should be used judiciously to avoid burning the skin. Hot and cold packs are useful adjuncts to exercise.
5) TENS. Some randomized controlled trials have shown benefits with TENS while other ones have failed to show benefit. As is the case with #2, try it out a few times. If it helps then continue and if not then its not for you. Given the available evidence, I would not advise patients to purchase a unit if money is tight.
6) Acupuncture. Some studies have shown that it helps while other ones have failed to show benefit. As stated above, you can try it a few times to see. If you don’t have insurance or if money is tight, I generally do not recommend it.