How to Get Back Pain Relief When Medication Isn't Working

You've tried stretching. You've taken ibuprofen. Maybe you even bought a new office chair or standing desk in an attempt to improve your posture. But that dull ache — or maybe it's a sharp, radiating pain — in your lower back just won't let up. Struggling to get through basic tasks pain-free, you're likely wondering what comes next.

The reality is, back pain is incredibly common, and while it often improves on its own over time, other times it can linger.

"The definition of when back pain is chronic can be a bit controversial, but it's usually defined as three months to six months (or more) of pain," says Dr. Sean Barber, a spinal neurosurgeon at Houston Methodist. "That said, you should not wait three to six months to seek help."

What to do when over-the-counter medication isn't enough for back pain

Most people start with ibuprofen or acetaminophen to manage lower back pain, and that's typically a good first step.

Ibuprofen belongs to a class of drugs called NSAIDs (non-steroidal anti-inflammatory drugs). Naproxen and aspirin are also NSAIDS.

"NSAIDs are anti-inflammatory medications that can be particularly helpful in the first 48 hours after an acute injury — a back sprain or a strain," explains Dr. Barber. "They're usually safe for most people to take for a few days, even a week if needed."

Problems can arise if you rely on NSAIDs longer than that, since these drugs can lead to stomach ulcers and gastric bleeding with prolonged use. "If you have a history of these issues, it's best to limit how often or how long you use NSAIDs, or maybe even avoid them altogether," Dr. Barber adds. "The same applies if you have kidney dysfunction, since NSAIDs can increase the risk of kidney damage."

Acetaminophen is an alternate option for back pain relief. It doesn't have anti-inflammatory properties and acts solely as a pain reliever, but it's generally safer for the stomach and kidneys. Acetaminophen comes with its own warning, though: "It can be bad for the liver if you take too much," says Dr. Barber.

(Related: Painkillers: Which OTC Medication is Right for Me?)

If your back pain hasn't improved after about a week of taking an over-the-counter pain reliever, it's time to see your primary care provider. "Or even if it's only been a few days but it's causing significant disruption in your daily life — you can't sleep, you can't go to work — you should see a doctor," recommends Dr. Barber.

Reasons to see a doctor more quickly include pain that radiates down your leg, weakness or inability to move your limb normally or changes in urinary or bowel function.

7 other ways to relieve back pain

Many back pain treatments exist, including:

• Stretching and low-impact exercise
• Heat and ice therapy
• Physical therapy
• Weight loss, if you're overweight
• Prescription pain medication
• Injectable medications
• Spine surgery

"Physical therapy is one of the mainstays of back pain treatment," explains Dr. Barber. "People often think they don't need it since they've already tried exercises and stretches for lower back pain on their own at home, but a physical therapist has a whole repertoire of skills and tools at their disposal to help with chronic back pain."

Chiropractic care can also be part of the plan, offering help with exercise, massage, stretching and heat therapy. But proceed with caution — especially when it comes to your neck. "Most chiropractic care is safe," says Dr. Barber. "But there are rare reports of high-speed neck manipulations causing injuries. There are arteries in the neck that can be injured with certain manipulations. It's best to avoid these high-speed manipulations, especially in the neck."

When is back surgery needed to address pain?

Most back problems are resolved with conservative treatment. "At least half of people get out of a back pain episode via one or more of these nonsurgical options," Dr. Barber says.

However, if your symptoms aren't improving after six weeks or more of conservative management — like physical therapy and prescription pain relief — your doctor may start a conversation about back surgery.

The type of spine surgery needed depends on the specific problem causing lower back pain. There are two main types:

• Decompression surgery, which relieves pressure on the affected nerve. "If a nerve is compressed by a herniated disk or stenosis, which is a narrowing of the spinal canal, the goal of surgery is to take pressure off that nerve, usually via a laminectomy, foraminotomy or a microdiscectomy," says Dr. Barber.
• Spinal fusion surgery, to stabilize the spine. "This is used when the bones in the spine are unstable — they are wiggling around too much — or when someone has a deformity of the spine and we're trying to correct the alignment," Dr. Barber explains.

Today, most back surgeries use minimally invasive techniques. "Even with fusions, we still perform them in the least invasive way possible," adds Dr. Barber. "For larger problems, like deformities, we often need to do a more invasive surgery, but we still limit as much collateral damage to normal tissue as we can."

The bottom line: If your back pain is getting in the way of your daily life, don't wait months to seek care. While over-the-counter medications can help, many treatments exist to help with back pain. And most people find relief without surgery. Talk to your doctor about what might be causing your pain and which treatments are right for you.