Back Pain: When Rest Isn’t the Answer
Back pain is extremely common, especially as we get older. An X-ray or MRI may show arthritis, narrowed discs, bone spurs, or other changes that sound alarming. But many of these changes are also found in people who have little or no back pain.
That is one reason treating back pain can be complicated.
Should You Rest?
Years ago, people with back pain were often advised to stay in bed until they felt better. We now know that prolonged bed rest can slow recovery and lead to muscle weakness and stiffness.
For most uncomplicated back pain, staying reasonably active is usually preferable. Walking and ordinary daily activities can often be continued as tolerated.
This does not mean ignoring severe pain. It means avoiding unnecessary inactivity while gradually returning to normal movement.
Exercise and Physical Therapy
Exercise can help people with recurring or chronic back pain improve strength, flexibility, and function.
There is no single best exercise program. Depending on the individual, a program might include walking, strengthening the muscles of the trunk and legs, stretching, balance exercises, or water exercise.
A physical therapist can be especially helpful when pain has persisted, movement has become limited, or someone has become uncertain or fearful about which activities are safe.
Can the Brain Learn to Reduce Back Pain?
An intriguing approach called Pain Reprocessing Therapy (PRT) is based on the idea that, for some people with chronic back pain, the brain may continue to interpret otherwise safe signals as threatening even after an injury has healed.
A randomized trial of 151 people with chronic back pain reported substantial reductions in pain, with many improvements continuing after treatment ended.
The results are encouraging, but the study involved a particular type of chronic back pain and participants were much younger than most HealthCurious readers.
More information on PRT in Emerging Treatments for Chronic Pain: What Looks Promising?
What About Medications?
Pain medications can provide short-term relief, but they generally do not address the underlying causes of chronic back pain.
Opioids may occasionally be appropriate for carefully selected patients, but because of their risks—including dependence, sedation, falls, and constipation—they are generally not a preferred long-term treatment for chronic back pain.
What About Surgery?
Back surgery can be very effective when there is a clearly identifiable problem that surgery can correct—for example, a compressed nerve causing persistent leg pain or weakness, severe spinal stenosis, or an unstable spine.
But surgery is generally less predictable for chronic low-back pain when there is no clear structural cause. Changes such as worn discs, arthritis, and bone spurs are common on scans as we age and do not necessarily explain the pain.
Before considering surgery, it can be worthwhile to ask: What exactly is the surgeon proposing to fix? How likely is surgery to improve my pain and function? What happens if I don't have surgery? And would a second opinion be useful?
For most chronic back pain, surgery is not the first treatment. But for the right problem and the right patient, it can make an important difference.
When Should Back Pain Be Investigated?
Most back pain is not caused by a dangerous condition. But sometimes pain is a warning sign of something more serious.
Medical evaluation is particularly important for new weakness or numbness, loss of bowel or bladder control, fever, unexplained weight loss, a history of cancer, or significant pain following a fall or other injury.
For older adults, a new episode of severe back pain after even a relatively minor fall can sometimes indicate a vertebral compression fracture related to osteoporosis.
Living With Chronic Back Pain
When scans do not reveal a problem that can simply be repaired, treatment often shifts toward improving function rather than trying to eliminate every sensation of pain.
For many people, regular movement, appropriate exercise, maintaining strength, good sleep, and gradually returning to valued activities can be more useful than prolonged rest.
The objective is not to pretend that pain does not exist. It is to prevent pain from unnecessarily determining how much of life remains possible.
Learn More
Mayo Clinic — Back Pain: Diagnosis & Treatment
A practical overview of back pain, including staying active, physical therapy, medications, and when additional treatment may be needed.
Mayo Clinic — When to See a Doctor for Back Pain
Helpful guidance on warning signs such as weakness, numbness, fever, unexplained weight loss, and back pain following a fall.
American College of Physicians — Treating Low Back Pain
Evidence-based recommendations emphasizing exercise and other non-drug treatments for chronic low-back pain.