This is the last of a three-part series on back pain. The first two columns were about causes and prevention. This one is about treatments.

This is the last of a three-part series on back pain. The first two columns were about causes and prevention. This one is about treatments.

Treatment for back pain generally depends on whether it is acute or chronic. Acute back pain usually gets better on its own. Treatment for chronic back pain is either nonsurgical or surgical. In most cases, back pain does not require surgery.

The following are common nonsurgical treatments for chronic back pain. They have varying degrees of support from the medical community. You should seek your own doctor's advice about any of them.

Hot or cold packs can be soothing. Exercise can help ease chronic pain and perhaps reduce its risk of returning. Medications are used to treat chronic back pain. These include over-the-counter pain relievers such as Tylenol; nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen that relieve both pain and inflammation; prescription narcotics such as oxycodone; topical analgesics such as Ben Gay; muscle relaxants and certain antidepressants. Traction, which employs pulleys and weights to stretch the back, pulls the vertebrae apart to allow a bulging disk to slip back into place. Injections into nerves, spinal joints or specific areas of pain. Spinal manipulation refers to procedures in which professionals use their hands to treat the spine or surrounding tissues. Transcutaneous Electrical Nerve Stimulation (TENS) involves wearing a small box over the painful area that directs mild electrical impulses to nerves there. Acupuncture, which involves the insertion of thin needles at precise locations, is used to relieve pain. In acupressure, no needles are used. Instead, a therapist applies pressure to points with hands, elbows or even feet. Rolfing is a type of massage involving strong pressure on deep tissues in the back to relieve tightness.

Some of the conditions that may require surgery include herniated or ruptured disks that are damaged and irritate nearby nerves; spinal stenosis, which is the narrowing of the spinal canal; spondylolisthesis, a condition in which a vertebra dislocates; vertebral fractures caused by trauma or crumbling of the vertebrae; and degenerative disk disease brought on by aging.

The following are some commonly performed back surgeries:

Laminectomy/diskectomy involves removing part of the lamina, a portion of the bone on the back of the vertebrae. The herniated disk is then removed. Microdiskectomy involving removing a herniated disk through a small incision in the back. The doctor uses a magnifying microscope in this operation. Laser surgery, in which the surgeon inserts a needle in the disk that delivers a few bursts of laser energy to vaporize the tissue in the disk. This reduces its size and relieves pressure on the nerves. Laminectomy, in which the doctor makes a large incision down the affected area of the spine and removes the lamina and any bone spurs, which are overgrowths of bone that may have formed in the spinal canal because of osteoarthritis. Spinal fusion, in which two or more vertebrae are joined together using bone grafts, screws and rods to stop slippage of an affected vertebrae. Disk replacement is an option when a disk is herniated. One alternative is to remove the disk and replace it with a synthetic disk.

Fred Cicetti is a freelance health-care writer from Sussex County, N.J. If you would like to ask a question, go to