Treatment

Most back pain gets better with home treatment within four weeks. If home treatments aren't working, your doctor may suggest:

Medications and therapies

• Medications. Prescription drugs such as nonsteroidal anti-inflammatory drugs and muscle relaxants may relieve mild to moderate back pain. When pain doesn't respond to simpler measures, your doctor may advise injecting cortisone — an anti-inflammatory medication — into the epidural space in your back to decrease inflammation in the area around the nerve roots.

• Heat or cold. When performed by a licensed professional, applications of heat or cold may relieve back pain caused by muscle spasms.

• Electrical stimulation. A therapist can use a small device to deliver electrical stimulation directly to the muscles of your back. This can relieve back pain from muscle spasms and strains. You may also try transcutaneous electrical nerve stimulation (TENS), a form of electrical stimulation that can suppress pain from sciatica, or a "pinched nerve." In this treatment, you place small electrodes on your skin near the area of your pain. The current isn't painful, and it may provide pain relief.

• Back schools. These programs, available in many communities, focus on managing back pain and preventing its recurrence. Classroom study generally involves back anatomy and function, followed by practice sessions on how to protect your back at home and work.

• Physical therapy and exercise. A physical therapist can use treatments and can manipulate and massage your back's tissues to reduce pain. As pain improves, you can help prevent back pain recurrence with an exercise program that increases your flexibility, strengthens your back and abdominal muscles, and improves your posture.

Surgical and other procedures

Only a few people ever need surgery for back pain. Surgery is usually reserved for certain kinds of back pain that haven't responded to more conservative measures. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Common back surgeries include:

• Laminectomy and laminotomy. These procedures, which involve removing part of your vertebra, may relieve leg pain caused by bone spurs or disk fragments that protrude into your spinal canal or press on nerve roots within your spine.

• Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A variety of metal implants also are available to help accomplish the fusion.

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