Managing Back Pain Without Relying on Painkillers

Have you experienced or are you currently experiencing low back pain? According to the WHO, “more than 80% of people will experience low back pain at some point in their lives. Low back pain is the single leading cause of disability worldwide, but the good news is that low back pain is also the condition for which the greatest number of people may benefit from physical therapy.”

Today, we will review evidence-based, long-term solutions for back pain relief without the use of painkillers. This is important because these solutions can minimize potential side effects from medications and potential dependence on medications, particularly opioids, which have long-term health consequences. Physical therapy takes a more holistic approach to address the root cause of the pain, which can promote long-term pain relief and management through healthy lifestyle changes and exercise.

Understanding Back Pain & Why Painkillers Are Not a Long-Term Solution

Myth: “Pain relief means the problem is gone” → Truth: Addressing the root cause is essential

There are many different factors that can contribute to low back pain. Common causes include muscle imbalances, overuse, long-term poor posture, or injury. Other risk factors for low back pain include low physical activity/sedentary lifestyle, smoking, obesity, and psychological factors such as stress, anxiety, and depression, which can exacerbate or contribute to the sensation of pain.

For the majority of low back pain, medication and painkillers should really be the last line of defense for pain relief. First, NSAIDs and opioids come with long-term side effects, including but not limited to organ damage, GI/cardiovascular issues, and addiction. The CDC recommendations state that for many types of acute pain, non opioid therapies are at least as effective as opioids, and non opioid therapies are preferred for subacute or chronic pain. So, why burden yourself with the side effects of painkillers when non-drug treatment can give you just as much benefit with the side effect of living longer!

Another downside to using any sort of painkiller or over-the-counter NSAID is that the medications only give you a temporary band-aid to mask your pain, which may give you a false sense of relief that the problem is resolved when it actually is not. In physical therapy, you can have a provider help you actually address the underlying root cause that might have led to pain in the first place. When these factors are addressed, you help reduce your chances of the pain recurring in the future, minus all the harmful side effects.

Evidence-Based Non-Drug Treatments for Back Pain

Myth: “Only surgery can fix chronic back pain” → Truth: Many cases improve with non-surgical treatments

A study by Sahin et al. looked at the effectiveness of physical therapy in patients with chronic low back pain. The research concluded that incorporating physical therapy modalities, such as exercise and manual therapy, significantly enhanced pain management and functional status compared to standard medical treatments.

At Onward, a trained clinician will utilize a variety of manual therapy techniques such as joint mobilizations, soft tissue work, and/or dry needling to help calm down the symptoms and improve your range of motion. Then, they will be able to provide you with targeted exercises to strengthen the muscles around your spine (core, back, and hip musculature), address mobility, provide movement re-education, and/or perform ergonomic assessments for posture to help reduce strain on your lower back. While it is sometimes difficult to exercise when in pain, it can also bring relief. The role of your PT is to individualize your exercise plan to the severity of your symptoms and properly guide you back into all of your daily and recreational activities again.

Movement & Exercise Strategies

Myth: “Rest is the best solution for back pain” → Truth: Movement is key to recovery

Active recovery over rest: As fitness-forward providers at Onward, the advice to “just wait and rest” is out. Instead, let’s use the medicine inside your body. Recent research has shown that walking or cycling at submaximal intensity for 20-30 minutes can decrease pain by 11-24% (Tan et al. 2022). Using the medicine inside your body is cheaper and stronger than pharmaceuticals. Our goal for you will be to find ways to move that don’t flare up your symptoms and help you get back to your activities more quickly!

Posture & Ergonomics Adjustments

We like to say your best posture is your next posture. There is no one specific position that is bad for you; however, staying in one position for long periods of time can increase strain on the spine, muscles, and nerves, which can contribute to low back pain. Also, a sedentary lifestyle at a desk can contribute to general weakness and tightness of the musculature surrounding the spine.

Simple strategies for desk workers throughout the office day can make a big difference including: setting an alarm for frequent movement/walking breaks every 1-2 hours, try to use a standing desk for at least 20-30 minutes in the morning and afternoon to break up the sitting, and proper ergonomic set up including chair height, lumbar support, and screen position.

For manual laborers, strategies such as improving lifting techniques, adjusting workstation height, using supportive footwear, using mechanical aids/tools, taking rest breaks or job rotations, and environmental adjustments can help fit the job to you in order to lessen muscle fatigue and reduce risk for injuries (www.osha.gov/ergonomics).

Alternative Approaches, Lifestyle Modifications & Mind-Body Approaches

Alternative Hands-On Therapies

Other non-drug approaches to treatment that could provide potential pain relief benefits for low back pain include massage therapy, chiropractic care, acupuncture, and heat/cold therapy.

Diet and inflammation

Utilizing an anti-inflammatory diet may help alleviate pain, not to mention provide many other overall health benefits. Incorporating foods like lean proteins, green leafy vegetables, turmeric, and omega-3s, but also cutting out things like processed foods and alcohol, could help to reduce your body’s overall inflammation and reduce lower back pain. A study published in The Journal of Pain found that individuals with chronic low back pain who followed an anti-inflammatory diet reported reduced pain sensitivity. Find a registered dietician near you to seek additional help with this!

Stress management techniques (Use of meditation, mindfulness, breathing techniques)

The brain is also a very inexpensive tool, especially for chronic low back pain. A randomized clinic trial with Cherkin et al.. concluded “among adults with chronic low back pain, treatment with mindfulness based stress reduction or cognitive behavioral training, compared with usual care, resulted in greater improvement in back pain and functional limitations.” Don’t underestimate the power of your brain! Using apps like Headspace or Calm are a great place to start!

Quality sleep

Sleep is another inexpensive yet crucial variable to the pain equation. According to Harvard Health, “The association between sleep deficiency and increased perception of pain is well known; poor sleep quality predicts greater intensity of pain from conditions such as back strain…In surveys of individuals with chronic pain, a night of poor sleep predicts worse pain. More or better sleep may lessen the pain you experience.

Talk to an Onward clinician about tips for sleep hygiene!

When to Seek Professional Help

Signs you should seek help from a physical therapist include: persistent pain >4-6 weeks, recurring episodes of low pain, difficulty moving/stiffness, pain going down the leg, pain affecting daily activities or work. However, at Onward, we think the earlier you start your interventions, the better. Instead of waiting for the pain to worsen or delaying you from your training/activities longer than necessary, come in within the first 1-2 weeks of pain onset. Our team of physical therapists can help tailor an individual program for you to address your specific problem, as well as provide you with the guidelines and appropriate programming for return to activity based on your level of pain and injury so you don’t have to fully lose out on your fitness and avoid leaving the gym.

Takeaways

The biggest key is to not give up hope! Your body is very resilient, and most episodes of low back pain recover with time alone. However, you can help reduce your recovery time, prevent chronic/recurring pain, and maintain fitness when dealing with pain by taking an active role in your healing process.

Your role:

• Stay moving
  • General physical activity, strength, flexibility, posture, movement patterns
• Use non-pharmacological tools for pain relief
  • Physical therapy, massage, heat/cold packs, acupuncture, chiropractic care
• Address lifestyle factors that can help reduce inflammation and pain
  • Get >7-8 hours of quality sleep, eat an anti-inflammatory diet, stress management/mindfulness, and avoid smoking

Looking for a fitness-forward provider who can help guide you through these treatments? Schedule with one of our expert clinicians who will help you manage your low back pain through a personalized program and get you back to doing all the things you love!

References:
Centers for Disease Control and Prevention. (n.d.). Non-opioid therapies for pain management. Centers for Disease Control and Prevention. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/nonopioid-therapies-for-pain-management.html

Cherkin, D. C., Sherman, K. J., Balderson, B. H., & et al. (2016). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. JAMA, 315(15), 1591–1601. https://jamanetwork.com/journals/jama/fullarticle/2504811?utm_source

Elma, Ö., Tümkaya Yılmaz, S., Nijs, J., Clarys, P., Coppieters, I., Mertens, E., Deliens, T., & Malfliet, A. (2024). Proinflammatory dietary intake relates to pain sensitivity in chronic nonspecific low back pain: A case-control study. The Journal of Pain, 25(2), 350–361. https://doi.org/10.1016/j.jpain.2023.08.015

Harvard Health Publishing. (2020, March 31). Pill-free pain treatments that won’t break the bank. Harvard Health. https://www.health.harvard.edu/pain/pill-free-pain-treatments-that-wont-break-the-bank

Occupational Safety and Health Administration. (n.d.). Ergonomics. U.S. Department of Labor. https://www.osha.gov/ergonomics

Şahin, N., Karahan, A. Y., & Albayrak, İ. (2017). Effectiveness of physical therapy and exercise on pain and functional status in patients with chronic low back pain: A randomized-controlled trial. Turkish Journal of Physical Medicine and Rehabilitation, 64(1), 52–58. https://doi.org/10.5606/tftrd.2018.1238

Tan, L., Cicuttini, F. M., Fairley, J., Romero, L., Estee, M., Hussain, S. M., & Urquhart, D. M. (2022). Does aerobic exercise affect pain sensitisation in individuals with musculoskeletal pain? A systematic review. BMC Musculoskeletal Disorders, 23(1), 113. https://doi.org/10.1186/s12891-022-05047-9

World Health Organization. (n.d.). Low back pain. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/low-back-pain