Four common mistakes in treating back pain and what to do next (excerpted from Consumer Reports, August 2014)

Mistake 1: Rushing to test

Back pain can be so intense that your first thought might be that you need an X-ray, CT scan, or MRI to see exactly what is going on with your spine. Most people who have those tests within a month of the onset of pain don’t get better any faster and may get worse. Why? Scans often show things that aren’t the cause of the pain but because they are abnormal findings,  prompt you and your doctor to pursue unnecessarily aggressive care. Knowing about those abnormalities might also increase your perception of pain leaving you hesitant to stay active, which is a key to recovery. In addition, CT scans expose you to unnecessary radiation. One study estimated that the 2.2 million CT back scans done in 2007 will lead to 1,200 future cancers.

When do you want an advanced imaging test? Good reasons include pain that doesn’t respond to self-help methods in a month, leg weakness, pain radiating from the buttock to a leg or from the neck or shoulder to the arm, a recent fall or accident, a history of cancer, and unexplained weight loss.

Mistake 2: Lying down

For decades, doctors recommended bed rest for back-pain sufferers. But a 2010 review found that patients advised to stay active reported less pain and a faster recovery. And new guidelines say that doctors should urge patients to resume normal activities as soon as possible and caution against staying in bed for longer than four days.

Mistake 3: Taking the wrong drugs

Doctors prescribe potentially addictive narcotic pain medications like oxycodone (found in OxyContin and Percocet) and hydrocodone (found in Lortab and Vicodin) to almost a third of back-pain sufferers. People who take these drugs report more disability after six months compared with those who don’t. The longer you use an opioid, the higher the dose you’ll need increasing the risk of addiction and side effects, and making it less likely that the drugs will help if you do need them, such as after surgery.

Some doctors prescribe steroid injections for pain related to osteoarthritis, but there’s little evidence that they help for anything other than back pain with sciatica (leg pain from a pinched nerve). Even then, effects wear off by three months.

And last, there’s nothing special about so-called backache pills such as Doan’s. They usually contain the same or similar ingredients found in other over-the-counter pain relievers.

Mistake 4: Having needless surgery

The number of back surgeries continues to rise each year. A 2013 study of Medicare patients found a 214 percent increase between 2000 and 2010. “There’s this perception that back surgery must work since it’s so expensive and requires so much recovery time,” said Roger Chou, M.D., a back expert and director of the Pacific Northwest Evidence-Based Practice Center at Oregon Health & Science University. But it often doesn’t. Because back pain often stems from arthritis, poor posture, weak muscles, and similar problems that can’t be fixed with surgery, this is not the best option. Even when the pain is caused by such conditions as a herniated disk or spinal stenosis (a narrowing of the spinal column), conservative treatment is often enough.

Consider surgery only if you have severe back and leg symptoms clearly linked to a herniated disk or spinal stenosis that hasn’t improved with conservative treatment in three months. Even then, surgery might not be the best option. “I tell my patients that while surgery can help them feel better faster, they can still get there—albeit more slowly—without surgery,” Chou said.

Alternative treatments for back pain

The following therapies might help some people. Consider trying these if basic self-help steps don’t work.

  • Spinal manipulation – if you have used ice for 24-48 hours and the pain is still there consider chiropractic care
  • Massage – if muscles continue to stay tight with stretching or when you know you have bad posture for extended periods of time
  • Acupuncture – for any pain that is persistent for more than 48 hours
  • Exercise – for strength and mobility, exercise is critical for recovery
  • Cognitive behavioral therapy – to help you train your brain with chronic pain syndromes