Backpain

There are a range of conventional and natural products available that might help back pain. 

For safe use of over-the-counter medicines, herbal remedies and supplements:
– if you have a serious medical condition
– if you are breast-feeding, pregnant or planning to become pregnant
– if you suffer from allergies

consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement

Registered herbal medicines (these bear the THR logo) will have a package insert. Read this before taking the product.

Avoid taking the product if you think you may be allergic to any of the ingredients.

Do not combine over-the-counter medicines, remedies or supplements with prescribed medicines unless you have first checked with your prescriber or a pharmacist.

Seek advice from your doctor or pharmacist:
– If your symptoms do not get better
– if your symptoms get worse
– if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

Summary
Capsaicin is the hot constituent in chilli peppers, and it offsets back and other joint pain by irritating the skin and inducing increased blod flow to the joints. You can get capsaicin on prescription but if it works for you it will be an excellent form of self-care pain relief.

Evidence
There is a very long tradition across the world of applying heat-generating remedies like cayenne and mustard to painful joints. It is likely that these remedies increase blood flow to the joint for longer than applying heat directly (see Using hot and cold packs in the Simple Changes section). There is some good evidence from research that, alongside the usual treatments, applying capsaicin can help with pain and tenderness in arthritic pain. 

Safety
Capsaicin is an irritant, and about one-third of patients get local adverse effects from capsaicin. A few people find this effect particularly troublesome, and even worse than the pain it is meant to offset.

Always read the package instructions before use, and avoid using capsaicin if you think you may be sensitive to it.

Use plastic gloves when you apply it. Keep it away from your eyes and wash your hands immediately after applying it. Keep it away from children. Wash it off any skin areas that do not need treating, using warm cooking oil, rather than soap or detergent.

Lemon juice or vinegar can reduce the burning.

Cost
Speak to your GP about prescription of this product. You may also buy it over the counter at around £6.

Further information
To find out more, see Ten things you should know about capsaicin

Summary
The idea of a corset, (or lumbar brace or support) is to strap the abdomen tightly so that there is little movement between the ribs and pelvis, and so that the pressure exerted by the tummy when breathing in straightens the spine. This also relieves the tendency of the muscles around the back to go into the ‘guarding’ spasm that so often contributes to the backpain. A well-fitted corset can also allow the backpain sufferer to carry on with daily activities.

Evidence
In one review corset treatment for chronic low back pain improved low back pain and increased muscle endurance for a short period of time. Associated muscle fatigue was not increased by long-term corset wearing, and muscle weakening was not observed up to 6 months after the start of corset wearing. 

Safety
Corset wearing seems to be safe. However best advice is to use them in the short term rather than come to rely on them.

Cost
A corset or lumbar brace can be obtained for up to £50.

Summary
This unusual plant from the desert regions of southern Africa has a thorny root, which the local people traditionally used as a remedy for arthritic problems. It is becoming rare nowadays in its natural state so it is important to buy only from reliable manufacturers who supply only farm-grown devil’s claw. Devil’s claw is available in the UK as a registered herbal medicine (marked by the THR logo on the package). This a guarantee that the important constituents and general quality will be assured.

Evidence
Some good research has found that taking devil’s claw can reduce low-back pain.

Safety
Most of the side-effects seem to be mild and uncommon and include stomach upsets.

Cost
A THR devils’ claw product will cost between £15-20 per month.

Summary
Simple analgesics (painkillers) can be helpful in managing persistent muscle pain. 

Evidence
Paracetamol works as well as ibuprofen in acute back pain and is less likely to give you side-effects. If it doesn’t work, then you could try ibuprofen, or codeine with paracetamol (co-codamol). Do take the recommended dose at the recommended intervals. Half doses of pain relievers taken now and then won’t work! They help most if you take the full dose four times a day. Drugs such as ibuprofen may not be so helpful if you have sciatica.

Safety
If used in the correct dose, painkillers are generally safe, but taking painkillers (whether prescription or over-the-counter) every day can cause side effects and lead to other complications, including even dependency. Do see your doctor is you are having to take painkillers constantly.

Side effects can include headaches, indigestion and even stomach ulcers or bleeding. Stop taking them if you start getting indigestion or stomach pain, and tell your GP or pharmacist. Always follow the stated dose.

Cost
Painkillers can be bought from pharmacies for low cost.

Summary
TENS is a way of delivering a small, pulsating current to your muscles and nerve endings. It is relatively easy and safe to use. Small electrical currents are sent through pads on the skin near the site of the pain. Several small studies have suggested that using TENS machines helps some people with long-term pain in general. 

Evidence
Several small studies suggest that using TENS machines helps some people with long-term back pain.

Safety
See the information sheet on TENS machines from Versus Arthritis for information on how to use TENS machines safely.

Cost
TENS machines are available from many pharmacies and some online retailers. They usually cost between £25 and £60 but this is a one-off cost.

Summary
Willow is the original source of aspirin. This has led to many authorities stating that it has same effects and risks. However the active ingredient salicin is quite different in its effects from aspirin. It does deliver the substance salicylic acid into the blood (notably without harming the stomach – this effect is caused by the artificial ‘acetylation’ of salicylic acid to produce aspirin and its non-steroidal anti-inflammatory derivatives like iboprufen). For the same reasons salicylate lacks the anticlotting properties of aspirin. It also has quite distinct antiinflammatory effects, probably working on mechanisms deep in the cell rather than the usual ‘COX and LOX’ mechanisms that are affected by aspirin and its derivatives.

The salicylates of willow are more concentrated versions of salicylates naturally found in many plant foods, vegetables, fruits and, and especially spices (blood levels of salicylates are highest in vegetarians, even higher in rural Indians). These natural salicylates have been shown to have many benefits and have even been called ‘vitamin S’.

Evidence
There is quite good research showing that white willow bark extract can be helpful in low back pain. The effective dose range is 800 to 1600 mg/day of willow bark containing 120 mg to 240 mg of total salicin.

Safety
A few of the safety issues that apply to aspirin are relevant to willow bark products. Don’t use it if you are allergic to aspirin or products like ibuprofen. Do not take it if you are breast-feeding, as it may make your baby sensitive to aspirin. Willow is probably safe in pregnancy but you should get advice from a healthcare professional before considering it. Let your doctor know if you are taking this remedy.

Cost
Willow bark supplements are available for up to £10 per month. Do ensure you obtain this from a reputable supplier.

Summary
Traditionally backpain has been managed with devices like trusses and corsets, and the application of packs to the affected area. These latter approaches are often similar to those used for arthritis (see traditional approaches to arthritis in the Osteoarthritis section for more).

As with arthritis the first principle across many cultures is to apply heat. Not only is there often temporary relief but if vigorous enough there could be something more lasting. Simple hot water bottles or hot packs are commonly applied but extra heating agents were also popular. These could include mustard, cayenne (chilli), ginger and horseradish. There are scientific studies that back all of these approaches: we now understand that these agents can ‘counter-irritate’ and reduce pain signals. Perhaps more significantly any heating increases circulation.

Most of the heating agents above can be used as homemade plasters, applied to a gauze strip and applied under a hot pack.

Safety
There are risks in applying heating agents although these are almost always only short-term. Some types of backpain can be exacerbated by heat – this will be obvious and will not last but is  good reason to stop this approach. If heat does suit then the stronger remedies may be carefully tried. Avoid open cuts or mucosal surfaces and keep a constant check to make sure the skin is not getting red too quickly. Blistering can occur in some with sensitive skin.

Cost
Most herbs should be inexpensive and can be bought from specialist suppliers. There are patented cayenne or capsaicin plasters that are more expensive.