Professional Help

If you are not able to do the exercise and behavior therapy on your own, you may need professional help through physical therapy or chiropractor therapy. If they are not helpful on their own, a behavioral therapist would also help. You may need a referral from your doctor to see a physical therapist or behavioral/ ACT therapist.

You may need pain medicines or spine injections to help you to be able to do the exercises. However exercise and behavior therapy are the goal of any pain medicines or even pain injections. Medicines such as over the counter ibuprofen, naproxen; and prescription medicines such as muscle relaxants, nerve medicines, antidepressants, narcotics as needed may be prescribed. The goal of these medicines, if at all used, is to mostly get you moving and able to perform the exercises. If they haven’t helped in the first couple of months, they are unlikely to help much for chronic back pain

Even if you do prefer tests, pain medicines, injections and surgeries, a trial of medically directed exercises for a couple of months should first be completed, before advanced testing for these is recommended or approved by insurance companies. This is because :

• Tests often show abnormalities that may not be the cause of your pain. Even if they are the cause of your pain (without a concerning exam), the treatment is still exercise for long term pain relief.

• Exercises with or without behavior therapy most often does help or calm down the pain. If pain recurs, same treatment done again does work.

• Injections afford only short term relief (few months). It is debated if pain relief long term at 8-11 years from surgery is better than with exercise+/- therapy, per some research trials.

• There may be placebo effects with some medicines/ injection procedures