It may also offer short-term pain relief and functional improvement for those with long-term (chronic) and subacute lower pack pain, but this benefit does not appear to be sustained after six months of treatment. There do not appear to be any serious adverse effects associated with massage. Acupuncture may provide some relief for back pain. However, further research with stronger evidence is needed. Spinal manipulation appears similar to other recommended treatments. "Back school" is an intervention that consists of both education and physical exercises. There is no strong evidence supporting the use of back school for treating acute, subacute, or chronic non-specific back pain. Insoles appear to be an ineffective treatment intervention. While traction for back pain is often used in combination with other approaches, there appears to be little or no impact on pain intensity, functional status, global improvement or return to work. Medication
If nonpharmacological measures are ineffective, medication may be administered. Non-steroidal anti-inflammatory drugs (NSAIDs) are typically attempted first. NSAIDs have been proven more effective than placebo, and are usually more effective than paracetamol (acetaminophen). Long-term use of opioids has not been tested to determine whether it is effective or safe for treating chronic lower back pain. For severe back pain not relieved by NSAIDs or acetaminophen, opioids may be used. Opioids may not be better than NSAIDs or antidepressants for chronic back pain with regard to pain relief and gain of function. Skeletal muscle relaxers may also be used. Their short-term use has been proven effective in the relief of acute back pain.
In most cases, the pain subsides naturally after several weeks. People who seek diagnosis through imaging are typically less likely to receive a better outcome than are those who wait for the condition to resolve. Imaging
Magnetic resonance imaging (MRI) is the preferred modality for the evaluation of back pain and visualization of bone, soft tissue, nerves and ligaments. X-rays are a less costly initial option offered to patients with a low clinical suspicion of infection or malignancy, and they are combined with laboratory studies for interpretation. Imaging is not needed for the majority of patients with back pain. In cases of acute back pain, MRI is recommended for those with major risk factors or clinical suspicion of cancer, spinal infection or severe progressive neurological deficits. For patients with subacute to chronic back pain, MRI is recommended if minor risk factors exist for cancer, ankylosing spondylitis or vertebral compression fracture, or if significant trauma or symptomatic spinal stenosis is present.Early imaging studies during the acute phase do not improve care or prognosis. Imaging findings are not correlated with severity or outcome. Laboratory studies
Laboratory studies are employed when there are suspicions of autoimmune causes, infection or malignancy. Laboratory testing may include white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Elevated ESR could indicate infection, malignancy, chronic disease, inflammation, trauma or tissue ischemia. Elevated CRP levels are associated with infection. Red flags
Imaging is not typically needed in the initial diagnosis or treatment of back pain.