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Easing your chronic back pain — with and without medication

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Is your back always aching? About 40 percent of people 18 and over and almost half of older adults experience this, typically in the lower back, according to a 2019 survey of almost 32,000 people.

Back pain is considered chronic if it continues for more than 12 weeks. In older adults, chronic low-back pain may be overtreated with inappropriate medications such as muscle relaxants or opioids, says Yury Khelemsky, program director of the pain medicine fellowship program at the Icahn School of Medicine at Mount Sinai in New York. It may also be undertreated, he says.

As it turns out, some of the most effective back pain strategies for those of us in this age group require no medication.

But you might not know this. “Older adults may not be offered behavioral treatments for pain due to an assumption that they won’t be interested, or a perceived stigma associated with such services,” says Sara Davin, a psychologist at the Center for Spine Health at Cleveland Clinic. “But these are the people that can really benefit from these treatments.”

To help you ease chronic back discomfort, here’s a look at the research behind nondrug treatments, and advice on how to use medication effectively.

The power of the mind

Research suggests that talk therapy may help you retrain your brain so you experience less pain and can cope with it better. “This isn’t suggesting that your pain is not real or that it’s ‘all in your head,’” says Tor Wager, professor in neuroscience and director of the Cognitive and Affective Neuroscience Lab at Dartmouth College in Hanover, N.H.

A study published last September in the journal PAIN Reports, for example, looked at psychophysiologic symptom relief therapy (PSRT), which addresses stress and other psychological issues that can contribute to persistent discomfort, and helps break associations that may set off pain, such as bending or sitting. This study found that 64 percent of back pain sufferers who tried PSRT reported being pain-free 6½ months later.

Also promising is pain reprocessing therapy (PRT), which “teaches people to perceive pain signals sent to the brain as less threatening,” Wager says. In a study published in JAMA Psychiatry, 66 percent of participants with chronic back pain reported much less or no pain after four weeks of the therapy.

Because PSRT and PRT are relatively new, and considered experimental, they are not always easily accessible or covered by insurance. Other talk therapy often is — and may be available in programs where patients work with a team of experts.

For instance, Cleveland Clinic’s Back on TREK program partners spine specialists, physical therapists and behavioral medicine experts. A study published in the journal Spine in 2019 found that people who participated for 10 to 12 weeks said afterward that their pain was less debilitating and they felt less depressed and anxious. “We also know these approaches can help reduce stress, which is important because pain triggers the release of stress hormones that make muscles tighten up,” says Davin, lead author on the study.

Interested? Davin suggests working with a psychologist or therapist who focuses on pain management. Your doctor may be able to suggest one, or check the American Psychological Association’s therapist finder (locator.apa.org).

A good posture prescription

“Pandemic posture” from, say, slouching over a computer or tablet from the comfort of your couch, has caused a rise in back and neck pain. Spending a lot of time on electronics may also lead to back muscle spasms and fatigue, Khelemsky says: “We’re not meant to sit at computers for eight to 10 hours a day at any age.”

To help with posture-related pain, Khelemsky suggests opting for a chair — not a couch — while using a computer or tablet. Sit with your back straight and your shoulders back, your rear end touching the back of the chair, and your feet flat on the floor. You can use a small, rolled-up towel to help support your back, and a foot rest, phone book or step stool to help your feet reach the ground while sitting. If you don’t have a chair that provides good back support, consider buying one.

Take frequent movement breaks, as well, says Colleen Louw, a spokesperson for the American Physical Therapy Association and director of therapeutic pain specialist certification for Evidence In Motion, which offers courses for health-care professionals such as physical therapists. Every half-hour, get up and stretch or take a short walk to relieve pressure on your spine.

Practice good standing posture, too: Whenever you’re on your feet, remind yourself to stand straight and tall with shoulders back, abdomen pulled in and feet shoulder-width apart.

Care for your core

While it may hurt to move around, staying active can help to relieve back pain, says Daniel Park, a spine surgeon at Beaumont Hospital in Royal Oak, Mich., and a spokesperson for the American Academy of Orthopaedic Surgeons. Weight loss, if appropriate, is also beneficial. “Losing just five pounds takes about 20 pounds of pressure off of your spine,” Park says.

But strengthening your back and core muscles — those around your pelvis, lower back, hips and abdomen — may be the key, Louw says. These naturally weaken as we age, leading to a loss of back support. That can cause chronic pain and, in turn, make common activities such as reaching to grab an item from an upper cabinet challenging.

Though core and back exercises are plentiful online, Louw recommends asking your doctor about physical therapy, where you’ll be taught strengthening moves that are safe and effective for you. “These should all be tailored to your specific needs and challenges,” she says.

Pain medications

Medication for chronic back pain “should be an adjunct for older adults, and not the main treatment,” says Roger Chou, a professor of medicine at Oregon Health & Science University in Portland. “It’s important to be cautious, and try to use the lowest dose possible, for the shortest period of time.” Here’s what to know about over-the-counter (OTC) and prescription medication options.

OTC drugs: Nonsteroidal anti-inflammatories such as ibuprofen (Advil, generic) are usually the first treatment of choice but might not be appropriate for older adults, says Chou — frequent use may raise heart attack and GI bleeding risks. (The same goes for prescription anti-inflammatories.) Instead, you can try acetaminophen (Tylenol, generic) for a week or two, staying under 3,000 mg a day, he says.

Rx drugs: If pain persists after a few months, you can ask your doctor about the antidepressant duloxetine (Cymbalta, generic). Muscle relaxants should be used with caution in older adults, says Chou — they can cause dizziness and hike fall risks. Groups such as the American College of Physicians advise against opioids like oxycodone (OxyContin, generic) as a first-line therapy for similar reasons.

How to handle a ‘back attack’

If your back starts to hurt suddenly, consider this expert advice:

  • Ice it intermittently. After a few days, try applying a heating pad or heat wrap.
  • Take acetaminophen, following package directions, for three to five days.
  • Move around as you can.
  • At night, lie on your side with your upper knee bent and a pillow between your knees.

Alert or see your doctor as soon as possible if you also:

  • Are experiencing unusual symptoms such as incontinence and pain or weakness in your legs. These may signal a serious issue.
  • Have fallen or been injured.
  • Have osteoporosis and back pain is sharp and jolting. You’ll want your doctor to rule out a compression fracture.

Tell your doctor if you:

  • Have fever along with sudden back pain or are in discomfort even when lying down.
  • Find that the pain lingers for more than four weeks.

Copyright 2022, Consumer Reports Inc.

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Read more at ConsumerReports.org.

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