Treatment

The treatment of back pain depends on the underlying cause, the severity of symptoms and how long the pain has lasted. In most cases, a combination of strategies can be used to relieve discomfort. These include non-pharmacological, pharmacological, interventional procedures and complementary approaches.

Non-pharmacological treatment

• Exercise and physiotherapy. Physiotherapy plays a key role in managing back pain. A physiotherapist can recommend and guide exercises that improve strength, flexibility and posture, helping to reduce pressure on the spine. Targeted exercises to strengthen the paraspinal and abdominal muscles are also beneficial in preventing relapses.
• Manual therapy. Techniques such as spinal manipulation or therapeutic massage can ease pain and improve mobility.
• Heat therapy. Applying heat (for example, with a hot water bottle or heat pad) can help reduce muscle stiffness and improve circulation, thereby easing pain.
• Relaxation and stress management. Stress can worsen back pain. Techniques such as meditation, deep breathing and yoga may help reduce muscle tension and promote overall wellbeing.
• Ergonomy. Maintaining a good posture and ensuring that the work and home environment (chair, desk, mattress, pillow, etc.) are suitable can help prevent back pain or stop it from worsening.

2. Pharmacological treatments:

• Common painkillers. Medications such as paracetamol, metamizole, and non-steroidal anti-inflammatory drugs (NSAIDs) like dexketoprofen, are useful for mild to moderate back pain.
• Muscle relaxants. These may be prescribed to relieve muscle spasms related to back pain, sometimes taken at night to ease stiffness and improve sleep.
• Stronger painkillers (opioids). For severe or persistent pain, opioids may be considered. However, their use is kept limited and generally short-term due to their addictive potential and possible side effects.
• Corticosteroids. In cases of severe inflammation, corticosteroids may be used to reduce swelling and pain, similarly to opioids, they're typically used for short periods due to their side effects.

Invasive treatments

• Injections and nerve blocks. In some cases, targeted injections in the affected area can effectively reduce inflammation and pain, and may be used for both acute and chronic back pain.
• Surgery. Surgery is only considered when the pain is severe, long-lasting and resistant to other treatments; when there are serious structural problems such as large disc herniations, spinal stenosis or fractures; or when neurological problems accompany the pain. The surgical approach is tailored to each individual case.

Other treatments

• Acupuncture. Some patients find relief from back pain through acupuncture.
• Supplements and nutritional therapy. In certain cases, vitamin B (particularly B12) may be considered when nerve involvement is present. Magnesium can help reduce muscle tension, while vitamin D, calcium and other nutrients may be recommended if back pain is linked to bone conditions such as osteoporosis.

Currently, the Pain Unit at Hospital Clínic offers a holistic, multimodal approach for patients with chronic back pain who do not improve with standard non-pharmacological or pharmacological treatments and who are not candidates for invasive treatments. This programme is known as PAINDOC.