Middle-aged or older patients with lower back pain?

Click below to see extension exercises you can do in your own home.

View Exercises

Try one knee or two knee raises to help flex and stretch lower back muscles.

Try knee rolls left and right to stretch and strengthen back muscles.

Try alternating between cat and camel postures to strengthen core and back.

Tips to avoid and prevent lower back pain
  • Early in the morning, avoid bending, leaning forward.
  • When lifting, bend at the knees and hips, not at the waist.
  • Avoid prolonged periods of sitting.
  • Get regular exercise.
  • Choose a diet rich in fruits, vegetables, and proteins.
  • Avoid artificial sweeteners, sugars, and processed foods.

What about non-opioid pharmaceuticals for back and neck pain?

Multiple professional organizations recommend starting treatment with non-pharmacological strategies. Click below to learn more.

What gives more pain relief? Placebo or...


Over-the-counter (OTC) medications such as Tylenol® , Advil®, or Motrin IB® are associated with only small effects on pain [relief] compared to placebo.

-Agency for Healthcare Research and Quality, February 29, 2016

Gabapentenoids – No more effective for chronic back pain or lumbar radicular pain.

-Shanthanna H, et al. Benefits  and safety of gabapentinoids in chronic  low back pain: A systematic review and meta-analysis of randomized controlled trials. PLOS Medicine, 2017; 14(8):e1002369.

Systemic Corticosteroids – No better at pain reduction or improving function for spinal stenosis or radiculopathy.

– Chou R, et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical  Practice Guideline. Annals Int Med 2017; on 4 April, 2017

“OTC medications are as effective as opioids for both pain control and function for chronic back pain and chronic degenerative joint disease pain in the knee and hip.”

– Krebs E, et al. Effect of opioid vs non-opioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA 2018; 319(9):872-882.

NSAIDs – Non steroidal anti inflammatory drugs are preferred as a first line pharmacologic therapy for acute, subacute and chronic back pain.

Duloxetine (Serotonin/NE reuptake inhibitor) is associated with reduced pain and improved function compared to placebo for chronic back pain.

Muscle relaxants are better than placebo for acute pain but are no better than placebo for chronic pain.

Acetaminophen is no better than placebo for pain, function or risk for serious events with acute back pain.

-Chou R, et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Annals Int Med 20 17; on 4 April, 20 17

An opioid is only an option when all other treatments have been considered.

Opioids are generally considered a short term treatment following a severe injury, illness or surgery. Long acting or extended release opioids are rarely appropriate for back pain. Click below to learn more.

What to expect from your physician
From moderate to severe back or neck pain, treatments other than opioids work better and have fewer risks.

  • Over-the-counter medicines include Acetaminophen (Tylenol® or generic), Ibuprofen (Advil®, Motrin IB® or generic), Naproxen (Aleve® or generic), topical non-steroidal anti-inflammatory drugs (NSAIDs), and heat rubs.
  • Non-Drug Treatments include exercise/activity, self-treatment methods, manual therapies/spinal manipulation, massage therapy/ acupuncture, cognitive behavioral therapy or injections such as steroids.
  • Other prescription drugs include NSAIDS, anti-seizure drugs, gabapentinoids and antidepressants.


This will include a physical and neurological examination to assess your pain including location, intensity, frequency and all the treatments you’ve tried.

Opioid effectiveness decreases over time
It’s quite common for people to develop a tolerance to opioids, which requires increasing the dose to help maintain the delivery of pain relief.
Potential side effects of opioids cannot be underestimated
  • Constipation
  • Drowsiness
  • Nausea
  • Vomiting
  • Chemical dependence
  • “Rebound” – increased severity of pain despite dosage.
  • Overdose
  • Death

There are more than 160 deaths per day in the U.S. from opioids.

Are steroid injections for back and neck pain usually necessary?

Care for back and neck issues should focus on physical treatments first. Steroid injections should only be considered when physical treatments aren’t progressing as expected. Click below to learn more.

A steroid injection can make sense
  • For diagnostic purposes
  • If justified by patient history
  • For physical exam
  • For imaging studies
  • For help in guiding further treatment

If there is radiating pain into the arms or legs a steroid can be justified by referral to a specialist to perform the procedure. Specialists include orthopedic surgeons, neurologist, anesthesiologist, physiatrist or a radiologist.

When a steroid injection can provide temporary relief
  • When there is inflammation or damage to a nerve, usually in the neck or the low back, it can help a patient engage in exercise therapy.
  • In cases of spinal stenosis, which can cause pain in the buttocks or legs while walking. An injection can relieve pain to allow for exercise therapy.

Questions? Text: #IQuestion or call 1.800.531.0987

Do I need a surgical referral?

Maybe. Maybe not. Being referred to a surgeon too early may actually decrease the quality of care or result in an unneccessary operation. Cliick below to learn more.

"Red Flag" symptoms that require surgical referral
  • Inability to go to the bathroom
  • Can’t control urination
  • Groin area numbness
  • Severe muscle weakness in the legs
What might a surgical specialist recommend?

A surgical specialist may suggest further physical treatment, physical therapy, massage therapy, acupuncture or prescribe injections. But in situations where issues are not improving with physical care, surgery can help correct an anatomical condition. For example, low back surgery can help correct a spinal instability or nerve pinching that isn’t improving after non-surgical care. Whenever possible, most specialists will only turn to surgery when all other avenues have been pursued.

Be sure to consider all options before surgery

Surgery should always be a last resort, especially if fusion is suggested.

  • Always consider getting a second opinion.
  • Spine surgeons may hold different opinions about when to operate and what surgery to perform.

Questions? Text: #IQuestion or call 1.800.531.098