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“Back pain is ubiquitous in our society, especially among older adults,” says Peter Whang, associate professor of orthopedics and rehabilitation at Yale School of Medicine in New Haven, Connecticut. “It’s usually due to degenerative changes we develop as we age, such as osteoarthritis or worn spinal discs.”
That said, there are effective treatments for pain and most don’t require medication, says Hamza Khalid, a spine specialist at the Cleveland Clinic. Consider these steps:
While exercise may not be appealing when your back hurts, staying active can help reduce pain and prevent it in the future. “Movement increases blood flow to the tissues of the spine and joints, which will help them feel better,” says Colleen Louw, a physical therapist and co-founder of Evidence in Motion in San Antonio.
A good place to start is doing pool aerobics or just walking in the pool, says Louw. These are gentle on the joints and build strength and confidence. “Once people realize they can be active without pain, it gives them confidence to do things when they’re out of the water,” he says. Other options include gentle yoga and the slow, gentle movements of the mind-body practice of tai chi. “They help stretch and strengthen your back muscles, as well as making you more comfortable with movement.”
You can also ask your doctor if seeing a physical therapist is appropriate for you. A physical therapist can provide you with an individualized exercise program and help you discover ways to move with less pain.
“Older adults tend to take shorter steps because their center of gravity has changed,” says Louw. “But short, narrow steps can make back pain worse. “We can work with them to make them more comfortable taking larger steps, which will increase blood flow to the spinal area.”
A physical therapist can also teach you “nerve glides,” Louw says, which are gentle exercises to stretch and calm irritated nerves in your back.
Use the power of your mind
Some doctors may recommend talking therapies to help change your reaction to pain and encourage you to set activity goals and work toward them. TO small study of 2021 in the journal Pain Reports, for example, discussed psychophysiological symptom relief therapy, which addresses stress that can contribute to pain. At the end of six months of such therapy, nearly 64 percent of patients reported being completely pain-free.
“The therapy is a good option for patients who have tried other conservative therapies, such as physical therapy, but have not been able to find relief,” says Khalid.
Ask your doctor where you can find psychotherapy for back pain. You may be able to find a pain management program at a large medical center. You can search the American Psychological Association therapist finder also.
It’s also important to manage everyday stressors and get enough sleep, says David Hanscom, a retired spine surgeon and author of “Back in Control: A Surgeon’s Roadmap Out of Chronic Pain.”
TO study 2022 published in Frontiers in Neuroscience found that sleep problems can trigger low back pain and vice versa.
Don’t just trust the massage
Various complementary treatments are sometimes used for chronic low back pain. They include massage, spinal manipulation (where a chiropractor moves the joints of the spine beyond their normal range of motion), and acupuncture (where very fine needles are inserted into specific points on the body).
Do they work? For short-term back pain, the American College of Physicians (ACP) recommends acupuncture, heat, massage, and spinal manipulation. But “I don’t consider massage and acupuncture to be first-line treatments,” Whang says. “These are more passive treatments, unlike active treatments like physical therapy, which teach you ways to stretch your back and keep your core strong.”
For massages in particular, a 2015 Cochrane Research Review concluded that while it helped improve back pain, the quality of the evidence was low. He also found that massage did not necessarily help with overall back function. Also, keep in mind that the therapies mentioned above are not always covered by insurance and can be expensive.
If you sometimes need more relief, over-the-counter anti-inflammatories like ibuprofen (Advil and generic) may be the first choice, according to ACP guidelines. But they’re often not appropriate for older adults, who may be at higher risk for side effects like gastrointestinal bleeding, says Jesse Charnoff, a physiatrist at the Hospital for Special Surgery in New York.
Acetaminophen (Tylenol and generic) may be a safer option if you stay below 3,000 mg per day, he says. Topical diclofenac (Voltaren Arthritis Pain and generic), an over-the-counter anti-inflammatory cream, may also provide relief. (But this and other anti-inflammatories may not be appropriate for people taking blood thinners.)
Another option may be an over-the-counter patch containing lidocaine, a numbing agent. For all of the above, consult with your doctor how often and for how long you can use them.
If you don’t see any improvement after treatments like physical therapy or medications like those mentioned above, the ACP recommends the prescription antidepressant duloxetine (Cymbalta and generic), so check with your doctor.
Prescription muscle relaxants like cyclobenzaprine (Flexeril and generic) can cause drowsiness and increase the risk of falls, so discuss your situation with your doctor. Avoid prescription opioids, which can cause dependence. They are no more effective than a placebo for low back pain in the short term, according to a 2023 study in The Lancetand can cause side effects such as constipation and dizziness, which may be more pronounced in older adults, Charnoff says.
Relieve acute flare-ups
For those times when discomfort increases, doctors say, these four strategies can help you feel better:
Move, but do it carefully. When you have severe pain, it is important to try doing some low-stress activities, such as walking and light stretching. “The biggest mistake people make is going on bed rest,” Charnoff says. “You will recover faster if you stay active. Move in any way that is comfortable for you and take slow steps to increase the activity you can tolerate.”
Try the heat. You can place a heating pad or wrap on the affected area. Apply it for 15 to 20 minutes straight, several times a day.
Take this medication as needed. Acetaminophen (Tylenol and generic) can usually be used for three to five days, following the dosing instructions on the package.
Position yourself so you can sleep comfortably. Try sleeping on your side with the top of your knee bent and a pillow between your knees. This puts the least amount of stress on the spine.
Tell your doctor if your discomfort interferes with your daily activities. Do the same if severe back pain persists for more than four weeks and you experience little improvement despite following some of the steps above.
Call a doctor right away if you have back pain even while lying down, or if the pain extends to your lower legs or is accompanied by fever, leg weakness, or bowel or bladder incontinence. The same applies if you have a history of cancer or osteoporosis, or if your back pain is due to a fall or accident. These symptoms and situations may indicate a potentially serious problem, such as a fracture or cauda equina syndrome, where the nerves at the base of the spine are compressed. Your doctor may want to see you right away or may advise you to see a specialist.
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