Most people with acute or subacute<unk>  improve over time no matter the treatment. There is often improvement within the first month. Recommendations include remaining active, avoiding activity that worsen the pain, and understanding self-care of the symptoms. Management of<unk>  depends on which of the three general categories is the cause: mechanical problems, non-mechanical problems, or referred pain. For acute pain that is causing only mild to moderate problems, the goals are to restore normal function, return the individual to work, and minimize pain. The condition is normally not serious, resolves without much being done, and recovery is helped by attempting to return to normal activities as soon as possible within the limits of pain. Providing individuals with coping skills through reassurance of these facts is useful in speeding recovery. For those with sub-chronic or chronic<unk> , multidisciplinary treatment programs may help. Initial management with non–medication based treatments is recommended, with NSAIDs used if these are not sufficiently effective. Non–medication based treatments include superficial heat, massage, acupuncture, or spinal manipulation. Acetaminophen and systemic steroids are not recommended as both medications are not effective at improving pain outcomes in acute or subacute<unk> . Physical therapy stabilization exercises for lumbar spine and manual therapy have shown decrease in pain symptoms in patients. Manual therapy and stabilization effects have similar effects on<unk>  which overweighs the effects of general exercises. Physical management Increasing general physical activity has been recommended, but no clear relationship to pain or disability has been found when used for the treatment of an acute episode of pain. For acute pain,<unk> - to moderate-quality evidence supports walking. Aerobic exercises like progressive walking appears useful for subacute and acute<unk> , is strongly recommended for chronic<unk> , and is recommended after surgery. Directional exercises, which try to limit<unk> , are recommended in sub-acute, chronic and radicular<unk> . These exercises only work if they are limiting<unk> . Treatment according to McKenzie method is somewhat effective for recurrent acute<unk> , but its benefit in the short term does not appear significant. There is tentative evidence to support the use of heat therapy for acute and sub-chronic<unk>  but little evidence for the use of either heat or cold therapy in chronic pain. Weak evidence suggests that<unk>  belts might decrease the number of missed workdays, but there is nothing to suggest that they help with the pain. Ultrasound and shock wave therapies do not appear effective and therefore are not recommended. Lumbar traction lacks effectiveness as an intervention for radicular<unk> . It is also unclear whether lumbar supports are an effective treatment intervention. Exercise programs that incorporate stretching only are not recommended for<unk> . Generic or non specific stretching has also been found to not help with acute<unk> . Yoga and Tai chi are not recommended in case of acute or subacute<unk> , but are recommended in case of chronic<unk>  pain. Stretching, especially with limited range of motion, can impede future progression of treatment like limiting strength and limiting exercises. Exercise therapy is effective in decreasing pain and improving physical function, trunk muscle strength and mental health for those with chronic<unk> . It also appears to reduce recurrence rates for as long as six months after the completion of the program and improves long-term function. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, but it improved pain <unk> ‐certainty evidence) and functional limitations outcomes (moderate‐certainty evidence) compared to other conservative treatments. There is no evidence that one particular type of exercise therapy is more effective than another. The Alexander technique appears useful for chronic<unk>  pain, and there is tentative evidence to support the use of yoga.If a person with chronic<unk>  is motivated, it is recommended to use yoga and tai chi as a form of treatment, but this is not recommended to treat acute or subacute<unk> . Motor control exercise, which involves guided movement and use of normal muscles during simple tasks which then builds to more complex tasks, improves pain and function up to 20 weeks, but there was little difference compared to manual therapy and other forms of exercise. Motor control exercise accompanied by manual therapy also produces similar reductions in pain intensity when compared to general strength and condition exercise training, yet only the latter also improved muscle endurance and strength, whilst concurrently decreased self-reported disability. Aquatic therapy is recommended as an option in those with other preexisting conditions like extreme obesity, degenerative joint disease, or other conditions that limit progressive walking. Aquatic therapy is recommended for chronic and subacute<unk>  in those with a preexisting condition. Aquatic therapy is not recommended for people that have no preexisting condition that limits their progressive walking. There is no quality evidence that supports pilates in<unk> . Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic<unk>  that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg. Evidence for the use of shoe insoles as a treatment is inconclusive. Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic<unk> . There has been little research that supports the use of lumbar extension machines and thus they are not recommended. Patients with chronic<unk>  receiving multidisciplinary biopsychosocial rehabilitation (MBR) programs are likely to experience less pain and disability than those receiving usual care or a physical treatment. MBR also has a positive influence on work status of the patient compared to physical treatment. Effects are of a modest magnitude and should be balanced against the time and resource requirements of MBR programs. Medications The management of<unk>  often includes medications for the duration that they are beneficial. With the first episode of<unk>  the hope is a complete cure; however, if the problem becomes chronic, the goals may change to pain management and the recovery of as much function as possible. As pain medications are only somewhat effective, expectations regarding their benefit may differ from reality, and this can lead to decreased satisfaction. The medication typically recommended first are acetaminophen (paracetamol), NSAIDs (though not aspirin), or skeletal muscle relaxants and these are enough for most people. Benefits with NSAIDs; however, is often small. High-quality reviews have found acetaminophen (paracetamol) to be no more effective than placebo at improving pain, quality of life, or function. NSAIDs are more effective for acute episodes than acetaminophen; however, they carry a greater risk of side effects, including kidney failure, stomach ulcers and possibly heart problems. Thus, NSAIDs are a second choice to acetaminophen, recommended only when the pain is not handled by the latter. NSAIDs are available in several different classes; there is no evidence to support the use of COX-2 inhibitors over any other class of NSAIDs with respect to benefits. With respect to safety naproxen may be best. Muscle relaxants may be beneficial. If the pain is still not managed adequately, short-term use of opioids such as morphine may be useful. These medications carry a risk of addiction, may have negative interactions with other drugs, and have a greater risk of side effects, including dizziness, nausea, and constipation. The effect of long-term use of opioids for<unk> er<unk>  pain is unknown. Opioid treatment for chronic<unk>  increases the risk for lifetime illicit drug use. Specialist groups advise against general long-term use of opioids for chronic<unk> . As of 2016, the CDC has released a guideline for prescribed opioid use in the management of chronic pain. It states that opioid use is not the preferred treatment when managing chronic pain due to the excessive risks involved. If prescribed, a person and their clinician should have a realistic plan to discontinue its use in the event that the risks outweigh the benefit. For older people with chronic pain, opioids may be used in those for whom NSAIDs present too great a risk, including those with diabetes, stomach or heart problems. They may also be useful for a select group of people with neuropathic pain. Antidepressants may be effective for treating chronic pain associated with symptoms of depression, but they have a risk of side effects. Although the antiseizure drugs gabapentin, pregabalin, and topiramate are sometimes used for chronic<unk>  evidence does not support a benefit. Systemic oral steroids have not been shown to be useful in<unk> . Facet joint injections and steroid injections into the discs have not been found to be effective in those with persistent, non-radiating pain; however, they may be considered for those with persistent sciatic pain. Epidural corticosteroid injections provide a slight and questionable
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