Back Pain Diagnosis and Treatment

Medically Reviewed by Tyler Wheeler, MD and Brunilda Nazario, MD on September 20, 2023
8 min read

When you have back pain, the goals of treatment are to make you feel better and to get you moving freely and easily again.

Your treatment options will depend on where your pain is and whether it's acute -- sharp and sudden, caused by something specific -- or chronic -- lasting more than 6 months, perhaps lingering after an injury or illness has healed.

Unless you can't move at all because of an injury, your doctor probably will test your range of motion, check how your nerves are working, and press on your back to zero in on the problem area. You might have blood and urine tests to rule out other problems, like an infection or a kidney stone.

Doctors generally use imaging tests for checking out ongoing pain, if your back was hit by something, when you also have a fever, or if you have nerve problems such as weak or numb arms or legs, too:

  • X-rays help pinpoint broken bones or other trouble with your spine. They can sometimes help find problems in connective tissue.
  • An MRI or CT scan can show your doctor what's going on with soft-tissue damage, such as a herniated disk.
  • An electromyogram (EMG) helps find nerve and muscle damage.

But there's not always a direct link between the results of these tests and how much it hurts.

Imaging tests typically aren't done when it's the first time you've had back pain or if your back hurts because you overdid it. Most back pain starts in the back and not the actual spine. Because it’s often related to the muscles of the back, the specific cause often can’t be found with imaging studies.

Your diagnosis will help your doctor decide what to do next.

The basic way to relieve a strain or minor injury is to take it easy for 24 to 72 hours. Use an ice pack and an over-the-counter pain reliever such as acetaminophen, aspirin, ibuprofen, or naproxen. After the inflammation calms down, a heating pad or pack can help soothe muscles and connective tissue.

If you have chronic back pain, sleep on a medium-firm mattress. You may be more comfortable sleeping with a pillow between your knees while lying on one side. Some doctors recommend lying on your back with a pillow under your knees.

Some other tips to try:

Keep good posture. Do this throughout the day. Be sure to listen to your body. If you feel sore or stiff, change your posture and your body mechanics.

Sit up straight. It feels better and puts the least amount of stress on your back. Arch your back five to 10 times if you feel stiff. This includes when you’re driving.

Take breaks. If you’re doing hobbies like quilting, sewing, and scrapbooking, don't look down for a long time without a break. Change your position and stretch in the opposite direction about every 20 minutes. Half-kneel or squat when gardening or cleaning.

Stretch regularly. This leads to good posture that you can keep doing with little effort. Try these stretching exercises at home or at your desk:

  • Shoulder rolls, backward, 10 times
  • Shoulder blade squeeze, 10 times
  • Chin in, 10 times
  • Chin in and slowly stretch your head back, 10 times
  • Turn your head over your shoulders, 10 times each way
  • Standing back-bend stretch, 10 times

Bed rest, which used to be what doctors advised for back pain, may do more harm than good. It could slow your recovery and cause new problems.

With acute pain, you should be able to start normal, easy activity, like walking, within a few days. After that, gradually ramp back up to your usual exercise level.

Strengthening both your abdominal and back muscles helps stabilize your spine. Pilates exercises build these core muscles. You can help prevent further back injury by learning -- and doing -- gentle stretching exercises and the right way to lift things.

Exercising in the water is especially safe for a sore back. The water supports some of your weight, which can make you more comfortable, and it offers gentle resistance, which builds your strength. Aquatic therapy can make you more flexible and lessen pain for chronic low back problems.

Yoga may help your flexibility, strength, and sense of balance. It's good for stress relief, which will also help you deal with the pain.

Physical therapy (PT) focuses on managing or preventing injuries or disabilities. PT helps relieve pain, promote healing, and restore function and movement.

Your treatment plan may involve visits to a specialist called a physical therapist. They focus on easing pain with passive or active therapy. Examples of passive physical therapy include:

  • Manual therapies
  • Heat or ice packs
  • Electrical stimulation
  • Ultrasound
  • Dry needling
  • Cupping

Examples of active physical therapy include:

  • Movement-based activities, including stretching and range-of-motion exercises
  • Specific strengthening exercises
  • Pain relief exercises
  • Low-impact aerobic conditioning

Keep in mind that each person may respond differently to therapy. People have different types of bodies, different patterns of movement, and different habits. Physical therapists and their trained staff can try to correct improper habits and movement patterns.

Over-the-counter painkillers such as acetaminophen(Tylenol), aspirin, or NSAIDs -- such as ibuprofen and naproxen -- can be helpful. If you're struggling to get through a normal day, your doctor may prescribe stronger pain medicines or muscle relaxants. But you have to be careful. Some of these prescription medicines can make you drowsy. You could also become dependent on hydrocodone/acetaminophen (Vicodin), oxycodone (Percocet), or other medications with opioids in them.

The antidepressant duloxetine (Cymbalta) may help with arthritis and chronic lower back pain. Doctors sometimes prescribe antidepressants and anticonvulsants for pain related to irritated nerves. Steroids that you swallow usually aren't recommended for acute low back pain.

If your primary doctor isn't able to help you control the pain, they may refer you to a back specialist or a pain specialist who might inject steroids or other drugs directly into your back to help control the pain.

Injections and procedures in and around the spine often give only temporary relief. But they can be important in helping diagnose structural causes of pain and helping in physical rehabilitation when other methods have failed. Injections are costly and have potential side effects, which should be discussed in detail before you start. Often, a pain specialist or back specialist will also use rehabilitation and counseling by non-physician personnel such as therapists, counselors, and patient educators.

Spinal manipulation can work for acute low back pain, but it may not be as effective for chronic back pain.

Getting chiropractic adjustments soon after you've hurt your back may prevent chronic problems later.

Osteopaths often combine drug therapy with spinal manipulation or traction, followed by physical therapy and exercise.

This ancient Chinese healing practice may bring relief for people with chronic low back pain. Gently placing thin, dry needles into your skin at specific points may trigger the release of endorphins, your body's natural painkillers, or it may change your brain chemistry so you have a higher pain tolerance. You should use it along with other treatments.

These procedures are intended for long-standing back pain and nerve damage.

Radiofrequency ablation uses radio waves to heat and to kill nerve tissue. That blocks the nerves from sending pain signals.

TENS, or transcutaneous electrical nerve stimulation, uses mild electrical currents for pain relief. A small, battery-powered device sends a signal through electrodes to tingle your skin. It may help by lowering your sensitivity to pain. 

Basivertebral nerve ablation may be an option if you've been diagnosed with vertebrogenic low back pain. The procedure destroys pain-causing nerves in your spine.

Intervertebral discs act as cushions between the vertebrae. Sometimes, the discs can become damaged and cause pain. IDET uses heat to modify the nerve fibers of a spinal disc and destroy pain receptors in the area. In this procedure, a wire called an electrothermal catheter is placed through a cut in the disc. An electrical current passes through the wire, heating a small outer portion of the disc to a temperature of 90 C. IDET is done as an outpatient procedure while you are awake and under local anesthesia.

Early studies show that some people may have continued pain relief for 6 months or longer. But more studies are needed to compare this treatment to standard therapies and surgery as well as placebo.

Radiofrequency discal nucleoplasty is a newer procedure that uses a radio frequency probe instead of heating wire to disintegrate a small portion of the central disc material. The result is partial decompression of the disc, which may help relieve pain caused by bulging discs pressing on nearby spinal nerve roots.

Cognitive behavioral therapy (CBT) can often lessen back pain, change how you think about your levels of pain and disability, and even lift depression. People have been able to take less medication while improving their outlook.

If your lower back pain is related to muscle tension or spasms, biofeedback can help you train your muscles to respond better to stress and movement. It may lessen the pain intensity and the need for drugs.

For most chronic back pain, this is a last resort. You may need surgery when you have a herniated disk or a pinched nerve from the spinal cord.

Diskectomy. Sometimes a disk, the cushion that separates your vertebrae, can slip out of place, press on a spinal nerve, and cause back pain. In a diskectomy, the surgeon removes all or part of the disk. 

Rhizotomy -- surgically cutting a nerve -- stops it from sending pain signals to your brain. The surgery can fix the symptoms caused by extremely damaged nerves and rubbing surfaces in a spinal joint, but it doesn't address other problems, like herniated disks.

Microdiscectomy - Microdiscectomy is performed with an operating microscope through a small incision and has become the standard surgical procedure for lumbar disc herniation. Sometimes a diskectomy is part of a larger surgery that includes laminectomy, foraminotomy, or spinal fusion.

Laminectomy. This is the most common surgery for lumbar spinal stenosis. In this procedure, a surgeon removes parts of the bone, bone spurs, or ligaments in your back. This relieves pressure on spinal nerves and can ease pain or weakness, but the procedure can make your spine less stable. 

Spinal fusion. This is the most common surgery for chronic nonspecific back pain with degenerative changes. The doctor will join spinal bones, called vertebrae, together. This limits the motion between them and how far your nerves can stretch. But it probably won’t limit your activity

There are also surgical treatment options are available for those with chronic pain that is resistant to treatments. These include sympathectomy, implantable spinal drug delivery systems, and implantable Spinal Cord Stimulator systems.