Your back consists of an intricate network of bones, muscles, ligaments, nerves and other tissues, so it’s no surprise that back pain treatments should include a variety of strategies.
Alone, each treatment option may offer some benefit, but when combined and under the guidance of a pain management specialist, back pain treatments can relieve your pain and improve your physical function.
“Anyone who has a ‘fix-it’ mentality, where you do one treatment only and think you’ll be good, is not thinking about the long-term trajectory,” explains Cleveland Clinic pain management specialist Kristin Powers, MD. “Each treatment may improve things by 25% or 30%, but altogether, someone might be 70% better, and that’s meaningful.”
Oral Medications for Back Pain Relief
Given their potential side effects, nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen and opioid pain medications—examples include hydrocodone (Lortab, Vicodin), oxycodone (Oxycontin, Percocet) and tramadol (Conzip)—are generally no longer prescribed for long-term management of chronic pain. And while acetaminophen (Tylenol) is generally considered a lower-risk alternative, its efficacy is limited, and too much of the drug can cause liver toxicity.
As alternatives, many specialists prescribe the oral anti-seizure drugs gabapentin (Neurontin) and pregabalin (Lyrica), as well as antidepressants like duloxetine (Cymbalta) and venlafaxine (Effexor), to treat chronic back pain. The anti-seizure medications calm overactive nerves and slow the transmission of pain signals, whereas the antidepressants increase the activity of two brain chemicals (serotonin and norepinephrine), thereby lessening pain perception. They also ease depression and anxiety, which can hinder chronic pain management.
If muscle spasms are contributing to your back pain, your doctor may prescribe muscle relaxants—examples include cyclobenzaprine (Flexeril) and metaxalone (Metaxall). “These are usually safe to use for chronic pain as needed or taking them every day,” Dr. Powers says.
Injections and Ablations
Your specialist may inject steroid medications into the epidural space of the spine to quell nerve inflammation and/or anesthetic drugs into spinal joints to numb the nerves. The injections are generally safe, but because chronic steroid use can cause side effects such as increased blood sugar, blood pressure, and weight, they’re limited to no more than four injections per year, Dr. Powers advises.
In a review summary of 90 studies (Neurology, March 11, 2025), the American Academy of Neurology reported “limited efficacy” of epidural injections, noting that they can provide short-term relief from pain related to spinal nerve compression (radiculopathy) and may reduce disability for up to six months or more in people with spinal stenosis, a narrowing of the spinal canal.
Dr. Powers notes that spinal injections can be effective when imaging studies show spinal disk herniation or stenosis, nerve compression and accompanying radiculopathy. “Patient selection is very important. We offer injections when there is an identifiable pathology on imaging, it’s targetable and it correlates with the symptoms. In those patients, injections tend to do really well,” she says. “If someone doesn’t do better after two or three injections, they’re usually not a good candidate for injections.”
For back pain resulting from arthritis in the facet joints of the spine or degenerative spinal disks, your doctor may recommend radiofrequency ablation, in which an electrode fed through a hollow needle inserted into a spinal nerve delivers radio waves that heat and destroy part of the nerve, thereby preventing it from transmitting pain signals to the brain. In two treatments before the procedure, your physician will numb the target nerve with anesthetic to see if it relieves the pain.
“When you do the ablation, you should have a high level of confidence that you’re targeting the source of the pain, because you’ve done two diagnostic nerve blocks,” Dr. Powers says. “By the time you get to the ablation, it usually works pretty well.”
Other Back Pain Treatments
Adding complementary treatments such as acupuncture and manual therapy—e.g., spinal manipulation therapy (SMT), therapeutic massage—can provide further relief of chronic back pain. SMT aligns the vertebrae and also corrects imbalances in the joints, muscles, and other tissues of the back to ease pressure and pain and improve range of motion. Acupuncture eases muscle tension and prompts the release of your body’s natural pain-relieving endorphins to ease chronic back pain and stiffness and improve physical function.
“Acupuncture is low risk and has been around for thousands of years, and it works in some patients,” Dr. Powers says. “It’s safe to try these treatments, and if they help, that’s great because they’re an easy, safe option.”
Importantly, chronic back pain treatments should address the mental as well as the physical aspects of chronic back pain. Cognitive behavioral therapy and other mental health strategies can help you combat stress and mood disorders so you can manage your pain more effectively.
“We know that people with poorly controlled stress, anxiety and depression have more difficulty controlling chronic back pain, so a good pain doctor should make sure it’s not one of the reasons why your pain isn’t improving with the interventions,” Dr. Powers says. “Cognitive behavioral therapy for chronic pain has been shown to be as beneficial as injections and medications. It’s a key component of treatment.”
Find Back Pain Relief
Many people with chronic back pain can be managed nonsurgically, but it takes time and a concerted effort to find the best treatment combination, Dr. Powers advises.
“We may be able to manage it right now and you’re good for three to five years, but at some point, the pain may come back,” she says. “The best thing to do is be willing to work through different treatments and not be discouraged if something doesn’t work. There isn’t a quick, easy fix, so sometimes it takes months to work through different treatment options to find a place where the pain is manageable enough where you can have good quality of life again.”
