Each year, Americans spend about $24 billion on treatments for back pain, according to the Arthritis Foundation. Most back pain can be successfully treated at home. These treatments should begin to relieve pain within 72 hours, although it may take weeks before the pain completely disappears. Treatments include:

• Over-the-counter analgesics. Medications including acetaminophen can ease pain, and nonsteroidal anti-inflammatorydrugs (NSAIDs) such as aspirin or ibuprofen can reduce inflammation, swelling and stiffness.  Even over-the-counter acetaminophen or NSAIDs are not without side effects, especially in higher doses, so talking to a physician before taking these medications is recommended.
  
  
• Application of cold (cryotherapy) and heat (thermotherapy). Start with cold compresses before moving on to hot compresses (or using hot baths instead of hot compresses). This technique can soothe sore and inflamed muscles. Cold treatment should be used first. Upon injuring the back, ice should be applied several times a day for up to 20 minutes at a time. Ice should not be applied to the back directly – there should always be at least a thin barrier between the ice and the skin. Cold treatments should be used as long as spasms persist.

Once acute pain has subsided – or after two or three days – heat from a heating pad or heat lamp should be used to loosen tight muscles. Again, applications should last no longer than 20 minutes. Although not scientifically proven to actually resolve back pain, these treatments do appear to reduce pain and inflammation and increase mobility for some patients.

• Activity. Light activity speeds up healing and recovery. Immediately stop any activity that aggravates the muscles. A physician, physical therapist or exercise physiologist can suggest appropriate exercises, which may include stretching, swimming or walking. Prolonged bed rest – more than one or two days – should be avoided.

In some cases, home remedies will not be enough to soothe back pain. If home remedies fail to offer any improvement in symptoms after 72 hours, patients should seek medical assistance. A range of medications or therapies can be used to help relieve back pain.

Prescription NSAIDs and muscle relaxants can be used to relieve mild to moderate back pain. In most cases, these medications are taken orally. However, they may also be given as counter-irritants. These medications are applied topically to the skin as a cream or spray. They are designed to stimulate the nerve endings in the skin to provide sensations of warmth or cold and to dull a patient’s sense of pain.

Other medications sometimes prescribed to treat back pain include:

• Anticonvulsants. These drugs, primarily used to treat seizures, may also be effective in treating certain types of nerve pain. Anticonvulsants are often prescribed with analgesics.
  
  
• Antidepressants. Some antidepressants, particularly tricyclic antidepressants, can relieve pain and assist with sleep. The U.S. Food and Drug Administration (FDA) has cautioned that antidepressants may increase the risk of suicide. People taking antidepressants should be monitored for unusual behavior.
  
  
• Opioids. Prescribed to manage severe pain, they should be used only for short periods of time under close supervision of a physician, as they can have numerous side effects, including drowsiness, decreased reaction time, impaired judgment, depression and potential for addiction.

Other treatments for back pain include:

• Spinal bracing. This may be used for conditions ranging from scoliosis to spinal cord injuries.
  
  
• Electrical stimulation (e-stim). A small device can be used to deliver electrical stimulation to the muscles of the back, relieving pain caused by muscle spasms and strains. Transcutaneous electrical nerve stimulation (TENS) may be used to suppress pain from a pinched nerve, such as sciatica. These treatments should be performed only by trained healthcare professionals, who can instruct patients in use of TENS at home. For severe cases, e-stim devices can be surgically implanted in the back.
  
  
• Manipulation therapy, physical therapy and exercise. Chiropractors can manipulate and massage back tissues to reduce pain. Massage therapy may also offer relief. Chiropractors or physical therapists can offer modalities such as deep-heating ultrasound therapy or iontophoresis, the use of electricity to deliver medication through the skin. As the pain improves, the therapist or physician can work with the patient to create an exercise program that will strengthen the back and abdominal muscles, increase flexibility and improve posture. Instruction in body mechanics will help prevent reinjury.
  
  
• Occupational therapy. If back pain limits daily activities such as self-care and household chores, occupational therapy can improve adaptation and maximize independence.
  
  
• Cognitive behavioral therapy. Patients learn to replace negative thoughts with positive ones. This treatment may benefit people with chronic pain.

Some patients with back pain also seek alternative approaches to treatment. These include:

• Acupuncture. Needles the width of a human hair are inserted into trigger points around the body. Advocates of acupuncture say that it releases natural painkilling molecules. Some clinical studies have found acupuncture helpful in relieving back pain. A variation is a needle-free treatment called acupressure.
  
  
• Biofeedback. A special electronic machine is used to help train patients to become aware of and gain control over muscle tension, heart rate and skin temperature. The purpose is to help patients change their response to pain through relaxation techniques.
  
  
• Injection therapy. A range of approaches are used, including injections of local anesthetics or corticosteroids into soft tissues, joints or nerve roots. In some cases more complex nerve blocks and spinal cord stimulation are used. Spinal cord stimulation may be another option.
  
  
• Traction. Involves the use of weights to apply a force intended to “pull” the skeletal structure into better alignment.

In rare circumstances, patients may need surgery to relieve their back pain. Patients who may benefit from surgery include those who have severe, consistent pain or progressive muscle weakness caused by nerve compression. Common spine surgeries include:

• Laminectomy and laminotomy. Part of a vertebra is removed to relieve pain caused by bone spurs or disc fragments that protrude into the spinal canal and press on the nerve roots within the spine.
  
  
• Discectomy. All or part of an intervertebral disc is removed.

• Fusion. Two vertebrae are joined to eliminate painful movement. Various metal implants may also be used to help reinforce the fusion.
  
  
• Vertebroplasty or kyphoplasty. These minimally invasive procedures inject cement-like material into vertebrae damaged by compression fractures, such as those caused by osteoporosis.
  
  
• Disc replacement. A synthetic disc is inserted between two vertebrae.
  
  
• Implantation of a spinal pump. In severe cases, a pump that delivers pain medication around the spinal cord can be surgically attached to the back.