Less than a cure, but better than nothing: thoughts on getting short term symptom relief from low back pain

Don’t knock good symptom relief … if you can get it. There are many painful situations in life where the “root cause” is untreatable and unknown, and symptom relief is the best you can hope for. Unfortunately, sometimes even that modest goal is elusive. A reader recently asked me:

How can I get relief from low back pain right now? Forget cure: I’d settle for treating the symptoms right now. Can I at least do that? Is there anything that can relieve the pain in the short term?

It only took a few moments of stumbling around to realize that there’s really no good answer to this question. “It depends” and “not really” came up pretty quickly. It depends on what the (usually unknowable) origin of the pain is, and, no, there’s not much that is likely to make the pain back off significantly … not even temporarily.

Still, even without a satisfying answer, it’s a good question to try to answer, and quite different than the question I’m usually trying to answer: how do we end low back pain?

Short term pain relief isn’t impossible, it’s just unreliable and unpredictable _ a crapshoot. There are many interventions that might provide relief, but none that can be counted on. If we lower our standards, here are some of the interventions that have a fighting chance of providing at least some respite from symptoms.

Drugs. It’s clear that medications are not an effective solution for low back pain — indeed, “it doesn’t even touch it” is a pretty common comment from frustrated patients, regarding even the most potent drugs. However, unreliable is not the same thing as useless. Some people, some of the time, can get a least a little relief from virtually any of them. Here are some brief comments on the most popular options. All are worth cautiously experimenting with, and all are problematic and pointless in excess.

The commonly used over-the-counter medications are anti-inflammatories like ibuprofen, Tylenol, codeine, alcohol and muscle relaxants.

• Acetominophen (Tylenol) and ibuprofen (Advil, Motrin, Voltaren gel) may provide mild symptom relief.
• Opioids are the nuclear option: codeine (most readily available in small doses in Tylenol IIs and IIIs) and “Hillbilly heroin” (Oxycontin, Percocet) are all capable of inducing deep relaxation, euphoria, and making you “not care” about the pain. They also have serious drawbacks, of course, such as turning you into a useless lump, and the hair-raising risk of a life-altering addiction. Before you try opioids for trigger point pain, ask yourself the question, “Do I want to risk a decade-long addiction and rehab drama?”
• Muscle relaxants come in several varieties, but only one that is widely available without a prescription: methocarbamol, as found in Robaxin, Robaxacet and similar brand names. The most famous muscle relaxant is diazepam, aka Valium, a benzodiazepene along with several other well-known drugs (Klonopin, Ativan, and Xanax). Like the opioids, the benzos are another “nuclear option” — they interfere with muscle contraction, but they also interfere with a great deal else: like consciousness! Unfortunately, muscle relaxants are amazingly ineffective: “these drugs have not been proven to be superior to acetaminophen or nonsteroidal anti-inflammatory drugs for low back pain” (See et al).
• Alcohol is hard on your system in many ways, and hangovers actually increase muscle pain. However, anecdotally, moderate usage seems useful for taking the edge off nearly any kind of pain via sedation and the “I don’t care if it hurts” effect.

“it doesn’t even touch it” is a pretty common comment from frustrated patients, regarding even the most potent drugs.

Ice or heat, whatever seems most appealing. Ice can backfire, aggravating muscle pain in particular, but it can also provide relief. Patients should choose what seems right: although odds favour heat, patient preference is always key. I am forever encountering patients who crave one, but have been told to do the other by a professional. Do what feels right. For instance, ice is most likely to be temporarily useful in patients experiencing acute, “hot” pain where there is a mostly aesthetic, non literal impression that the region actually needs to be cooled down — so cool it down! But be ready to switch to heat when ice starts to feel less appealing. Or vice versa. Heat is more likely to appeal to most low back pain patients. Taking your time with a good hot bath or shower is one of the most reliable symptom relief tactics — although it’s virtually guaranteed to be minor and temporary, at least it has a fighting chance of taking that edge off. Heat is also virtually risk free.

Mobilizations, stretching and traction — which I collectively think of as “wiggling and squirming therapy,” the common denominator being movement — all have the potential to relieve symptoms … but also considerable potential to worsen them, depending on the case. How far to push it is a difficult question, because breakthroughs are possible with persistence. Swinging your hips around in a circle 20 times may do absolutely nothing, but 50 times could both help or hurt. Intense, risky stretching has been known to succeed where moderate stretching failed … and, of course, it’s also been known to injure people. It’s a gamble.

Chiropractic adjustment (spinal manipulative therapy) has been proven to be modestly effective in the treatment of low back pain — roughly equivalent to drugs (for a good recent research example, see Jüni et al). Despite its underwhelming benefits for most people, it might be worth pursuing as a symptom relief option because a few patients do get greater relief, and because SMT’s benefits are infamously temporary — i.e. unlikely to “cure,” but perhaps helpful for managing symptoms. Unfortunately, this is the least convenient and most expensive of the options presented here, and there are risks: some people’s symptoms are worsened, not helped, and the danger seems to be greatest with the patients most likely to seek help (nasty, acute cases where anxiety is strong).

Self-massage will fall flat in many cases, but it probably has the greater potential for substantive symptom relief than spinal adjustment, with lower risks, and free — just lie down on a tennis ball. If I had to choose just one pain relief strategy for low back pain, it would undoubtedly be self-massage. Like chiropractic adjustment, benefits of basic massage are infamously temporary — but at least it’s safe and cheap to try!

If I had to choose just one pain relief strategy for low back pain, it would undoubtedly be self-massage.

I’d love to hear some other suggestions by email. Have you come across a method of relieving low back pain? Something that’s less than a cure, but better than nothing?