Back Pain: Finding solutions for your aching back

When back pain strikes, you may think the best way to get relief is to sit still or lie down until the pain goes away. But we now know exercise can be key to treating back pain. In fact, thanks to the pioneering work of back pain researchers, effective treatment has undergone a sea change.

That’s why the experts at Harvard Medical School created Back Pain: Finding solutions for your aching back. This report reviews common types of back problems and the treatments that are most likely to bring you relief. For example, you’ll discover:

• 3 symptoms that mean your pain is probably caused by a herniated disc
• Why men are more likely to suffer from disc problems and need surgery
• The type of back pain that can come from being out of shape
• Why uncovering the cause of back pain can be so difficult
• If opioid pain relievers can ever be used safely
• The best way to prevent repeat episodes of back pain

You’ll get a detailed overview of how your back is put together and the role your vertebrae, discs, muscles, nerves and more play in helping you to twist, turn, bend, stand, walk, run, and lift. Knowing this information makes it easier for you to understand:

• The reason your abdominal muscles are so important to your lower back.
• Why MRIs and X-rays are considered overused when it comes to most back pain.
• Why the best approach to back pain is “wait and see” unless you have a red-flag symptom.
• “Just-in-case-tests” that could lead to unnecessary surgeries.
• Why 90% of people with sciatica or herniated discs will recover on their own within 6 months.

And this is just a fraction of the important, pain-relieving, back-pain-preventing information you’ll find in this report. You’ll see:

• The type of compress that helps promote healing
• Why you don’t want to spend too much time in bed after a back injury
• 7 crucial questions to help decide if you need surgery
• How to tell if a firm mattress is causing your back pain
• How lack of exercise can trigger back pain
• 9 ways to take pressure off your back
• And so much more

This report was prepared by the editors of Harvard Health Publishing in consultation with Jeffrey N. Katz, MD, MSc Professor of Medicine and Orthopedic Surgery, Harvard Medical School; Vice Chair for Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, 53 pages. (2025)

Stick with treatment guidelines

Although doctors weigh treatment options on a caseby-case basis, expert guidelines—which are based on scientific data—help set standards for best practices.

Recommendations from the American College of Physicians (ACP) advise people with acute low back pain to start with nondrug therapies like heat, massage, acupuncture, or spinal manipulation (chiropractic). The World Health Organization (WHO) issued similar guidelines in December of 2023. Both the WHO and ACP recommend nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin) and naproxen (Aleve), as firstline options for pain medication.

Similarly, for chronic back pain, these groups recommend nondrug approaches first. NSAIDs can be taken if needed, but should be limited to the shortest possible period of time because of the risk of gastric irritation and bleeding.

• Why is back pain so common?
• What puts you at risk for back pain?
  • The anatomy of your back
  • Vertebrae
  • Discs: Your back’s shock absorbers
  • A flexible, protective column
  • Muscles, ligaments, and tendons
  • Nerves
• Types of back pain
  • Sprains and strains
  • Nerve-compression syndromes
  • Arthritis, including ankylosing spondylitis
  • Spondylolisthesis
  • “Red flag” symptoms and conditions
• Diagnosing back pain
  • Your medical history and exam
  • Diagnostic imaging: When it is and isn’t useful.
  • What tests can help diagnose back pain?
  • Tests used less commonly to diagnose back pain
• Creating a treatment strategy.
  • Factors to consider
  • What can you do?
  • What can your doctor do?
• SPECIAL BONUS SECTION: Beyond drugs and surgery—other ways to help your back
  • Medications for back pain
  • Over-the-counter pain relievers
  • Prescription pain relievers
  • When is surgery an option?
  • Weighing the risks and benefits of surgery
  • Surgery for disc disease
  • Surgery for spinal stenosis and spondylolisthesis
  • Surgery for compression fractures
  • Surgeries for other back problems
  • Recovering from back pain
  • Five rules for a safe comeback
• Resources
• Glossary

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