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Conventional Treatment.
Conventional management of back pain is considered the
standard of care [39]. The basic elements of conventional treatment, according to [5],
are the following:
Nonsteroidal Anti-inflammatory Drugs (NSAID).
Such anti-inflammatory drugs are
usually used in order to reduce the inflammatory reaction as well as the pain level of
the patient [22]. One systematic review of 51 randomized controlled trials comparing
NSAIDs with placebo showed that NSAIDs significantly improve pain control, so
they are recommended for the treatment of back pain, as cited in [21].
Muscle relaxants.
It is maybe the most common drug therapy and involves the use of
muscle relaxants mainly for pain relief purposes. Similarly to NSAIDs, evidence from
studies and trials showed that they are helpful in the treatment of back pain, especially
when combined with NSAIDs. However, there might be side effects depending on
each person using them, something that might limit the usefulness of these drugs, so
they should be used with caution, as cited in [21].
Local injections.
There is a wide variety of injections that could be used for both
diagnostic and therapeutic purposes, and are considered an alternative to the oral
methods of NSAIDs and muscle relaxants [22]. One of the most common injections
used is the Trigger Point (TP) injection, which is considered to be one of the most
effective methods by most clinicians, as described by [42], since it is directly inserted
until it reaches the pain trigger point resulting in immediate pain relief.
Controlled physical activity.
This treatment plan refers to a short period of bed rest,
progressive mobilization, and exercise as the patient's pain improves [5]. However,
using bed rest as treatment is found to be controversial [39], thus, suggestions from
literature indicate that a patient should not stay in bed for longer than two days [21],
[5], [39]. As far as patient exercise is concerned, although it is usually suggested as a
treatment option, a meta-analysis of 10 trials of structured exercise therapy compared
with no exercise showed that there was no improvement in pain using back exercises,
so they are not considered helpful.
Physical modalities.
The main physical modalities used are cryotherapy or ther-
motherapy, meaning applying ice or heat on the pain point. Probably the most com-
monly used is the application of ice, however, there is minimal evidence regarding the
use of ice as a treatment option, whereas the application of heat was found to be help-
ful in reducing pain and increasing function, as cited in [21].
Alternative Treatment.
In addition, patients many times turn to alternative options
that could be used either in parallel to conventional therapy, or alone in order to cope
with pain that was not previously relieved using conventional treatment. These op-
tions are usually one, or more of the following:
Acupuncture/acupressure.
This method is considered to be one of the oldest forms of
local injection therapy, and it is usually used by physicians or chiropracticioners.
Treatment-wise, there is limited evidence regarding the use of acupuncture in back
pain, however in overall, higher-quality trials provide evidence that it is not benefi-
cial, as cited in [21].
Transcutaneous Electrical Nerve Stimulation (TENS).
Accordingly, TENS is a quite
popular physical modality method amongst patients and physicians alike, however, as
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