Non-operative management of LBP includes rest, pain pills, anti-inflammatories and muscle relaxant drugs. Non-narcotic (not derived from opium) pain relievers should be tried and opiates limited to severe pain for a week or two. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are also used, as well as muscle relaxants such as diazepam. A local “poultice” on the back (not the leg), such as SalonPas containing aspirin and menthol and/or a heating pad on the back also may help.
Addiction risk for opiates is high, despite claims that pain is their “antidote” and that if a person takes them for pain relief and not to get “high”, they will not get addicted. Recent reports on the drug Oxycontin tends to obviate that rule and opiates are not recommended for treatment of benign chronic pain.
A bed with a firm mattress seems to help, probably because it keeps the spine in fairly normal alignment whether lying on the back, stomach or side. A board under a mattress works most times and the mattress can be padded with “egg crate” foam to reduce discomfort.
Sometimes a lumbar support back brace helps by taking some weight off the lower spine and reducing excessive motion. A lumbar support with drawstrings for tightening then holding with Velcro is most popular now.
A brace seems to help when working over a sink, stove or workbench and when driving. Short trips are OK, but long car trips make most people with HNP worse. The reason isn’t known. It’s thought that the repeated motion and vibration of a car aggravates the HNP. It could be just the prolonged sitting.
Back exercises are often prescribed, but nobody knows of one that always works. Avoid sit-ups and “crunches” – they put a lot of force on the discs in the lower spine. It’s hard to strengthen spine muscles without increasing pressure on a HNP. An exercise program prescribed by an LPT, a licensed physical therapist, who “specializes” in back problems (most spine surgeons know who they are) is highly recommended.