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If you have chronic lower back pain—meaning a nagging ache has persisted for 12 weeks or more—you may be tempted to throw a bunch of Dr. Google remedies into a bag, shake it up, and start drawing at random. Before you go that unscientific—but understandably desperate—route, know this: The World Health Organization (WHO) released guidelines in 2023 that aim to demystify the dizzying array of options that promise to put an end to the hurt.
We asked doctors for their back pain tips, and for insight into some of the WHO’s top recs. So, let’s forget the remedy roulette and stick with the science, shall we?
What to do for lower back pain
While there’s nothing wrong with bed rotting, it’s not a great solution for a bad back. Based on nearly 70 different studies of more than 4,000 people in 20 different countries, the WHO concluded that exercise, including structured fitness programs that are prescribed or planned by health care practitioners, really works.
Erich Anderer, MD, chief of neurosurgery at NYU Langone Hospital–Brooklyn, tells SELF that it’s the number one prescription he sends many of his patients home with. “Even though it kind of feels counterintuitive, actually doing some light exercise and stretching through an acute episode of back pain will sometimes activate those muscles and get you to a point where you can kind of push through and then work on core strength to prevent a recurrence,” he says. Studies suggest that just about anything is helpful—yoga, Pilates, walking, swimming…the list goes on. For an added benefit, you can throw in some core-strengthening moves.
Jared Kaplan, founder of Arrive Wellness, previously told SELF that he suggests movements like the dead bug, clamshell, and glute bridge to strengthen muscles and lessen pain. (You can find instructions on how to do these moves in our hip abductor series.)
Are you still looking for another way to relieve your back pain? Head to the physical therapist’s office, Wesley Bronson, MD, a board-certified spine surgeon for the Mount Sinai Health System, tells SELF. “The mainstay of non-operative treatment, for me, generally begins with physical therapy, which works on restrengthening the core in the back and improving the muscular envelope that supports your spine,” he says.
Physical therapists understand how bodies work and can tailor movements and treatments specifically for you. The WHO notes that some types of PT are better than others, specifically spinal manipulation therapy or massage.
The WHO recommends that doctors educate people about the importance of prioritizing self care, which Dr. Anderer says is less about getting manicures and facials and more about eating nourishing foods, meditating, and partaking in (you guessed it) physical activities like yoga or Pilates.
Many of these tactics are believed to work because they lower stress, which can help you side-step the impact of back pain. For example, a study in Nature found that people who experienced even mild stress were 1.5 times more likely to have back pain than those who did not. As for those who experienced severe stress? Their chances jumped up 2.8 times.
It’s probably no surprise that the road to feeling relaxed and at peace often begins with a therapist. Studies have shown that cognitive behavioral therapy (CBT)—which focuses on identifying less-than-helpful thoughts and behaviors and taking specific steps to address them—in particular can help with managing chronic lower back pain.
“CBT has many, has many uses from a psychological perspective," Dr. Bronson says. A 2022 meta-analysis of 22 studies suggested that people with chronic lower back pain who tried it had less pain and disability than people who had regular care without CBT. The WHO recommendations hinge on the idea that, while pain does happen, the road to feeling better can involve changing how you think and what you do about it.
NSAIDs—such as ibuprofen or naproxen—are anti-inflammatories, so taking them may help you get on track to recovery, Dr. Anderer explains.
For what it’s worth, Dr. Anderer cautions against just popping an Advil or two here or there. That can help relieve pain in the moment, but it isn’t going to help you deal with the inflammation behind the pain, he says.
Because NSAIDs can cause serious problems in some people like gastrointestinal bleeding, stomach ulcers, and kidney damage, Dr. Anderer suggests speaking with a health care provider who can monitor your back pain, direct you to take the right amount of medication for a safe length of time, and watch for worrying side effects.
The WHO recommends that they be used in combination with other treatments and for the briefest amount of time, and only in people who are good candidates for the meds—i.e., those who don’t have kidney, stomach, or other health problems that might be an issue.
Three things that don’t work for lower back pain
Prescription narcotic medications have a well-documented history of being addictive, and they played a role in the estimated 100,000 overdose deaths in 2021 alone. “You have to look no further than the crisis itself, which I think is sort of precipitated in large part by a lot of very well-meaning doctors treating patients for pain syndromes,” says Dr. Anderer. “Chronic back pain is one of them, so that was one of the diagnoses that really fueled the opioid crisis.”
Besides being habit-forming, they don’t seem to work. At least one randomized clinical trial found that opioids were no better than the placebo at relieving back pain, but people who took them were at risk of misusing them a year after the trial was completed. The WHO specifically advises against the drugs, which include medications like OxyContin and Percocet, as “there are potentially serious adverse events associated with the use of opioid analgesics, such as dependence and overdose.”
Remember the advice to get exercise, seek out physical therapists, and invest in self-care? Yeah, well, according to experts we spoke with, a back brace or support belt encourages you to do the opposite. Experts say it’s a quick-fix approach that doesn’t really work.
“Everyone asks for a brace,” says Dr. Bronson, “which I generally recommend against in the absence of some trauma that requires it.” Since the goal is to strengthen the back, “the last thing you want to do is wear a brace,” he says. “It’s sort of like using a crutch while trying to strengthen your leg.”
There isn’t strong scientific evidence that they help prevent or relieve chronic back pain, and what’s more, the WHO says that “long-term use of these assistive products may be associated with harms, including dependence, fear avoidance of movement, and deconditioning.”
If you’re going to try PT, there’s one asterisk that we want to mention. The WHO and doctors we spoke with all say you should avoid traction, a technique where a harness device (or a therapist’s hands) are used to pull on the back, supposedly to alleviate pain by lengthening and reducing pressure on the spine.
At best, the research suggests that the practice offers no improvements. At worst, the WHO says that some studies have suggested that those treated with traction may be more likely to need surgery and have their neurological symptoms get worse. To make sure that you’re getting the right treatment, skip the traction, and better yet, ask your doctor and physical therapist to work hand-in-hand to develop light stretching (that you do yourself!) and bodyweight exercises that will get you back on your feet.
It’s unlikely that most health care providers will offer you opioids or a brace, but if they do suggest something that the WHO advises against, question them about it, or better yet, get a second opinion. When it comes to your body and your health, you have to be your own advocate—and this list can serve as a starting place for that.
Dr. Anderer also says it’s best not to wait until the pain becomes unbearable before you seek help. “I talk to patients all the time where they're like, ‘I kind of noticed it one day, but then it slowly got worse until the point where it was this rip-roaring pain that was life-altering.’” He says that if you can break the pain feedback loop when the pain is still acute (i.e., less than 12 weeks have gone by), you’ll put yourself in a better place to manage it in the long run.
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