NonOp

Non-surgical options for back and neck pain.

Understand the options, what research suggests, and what to ask your clinician.

Where to start Explore options

Most back and neck pain gets better with time and simple care. Only a small number of people ever need surgery.

Explore by category

Browse 21 guides at your own pace. Being in this library does not mean an option is right for you.

Start with movement and everyday self-care in Where to start. Options may overlap, repeat, or be skipped.

All guides, A–Z

At home

Cold

Cold can numb a sore spot for a short while, and some people like it in the first days after a strain. The research on cold for back pain is thin.

  • Ice and cold therapy

    A cold pack or wrapped ice placed on a sore back or neck to numb pain for a short while, though research on how well it works is thin.

At home

Heat

Warmth can ease tight muscles, and back pain guidelines include it for a new bout of low back pain, though the benefit in studies is small and short term.

  • Heat therapy

    Warmth from a heating pad, heat wrap or warm shower, which may ease recent low back pain a little for a short time.

Moving again

Physical therapy and movement

Gentle, regular movement is a core part of care for most back and neck pain, and guidelines put it among the first steps. A physical therapist or a good class can guide it.

  • Physical therapy

    Exercise, education and some hands-on care from a licensed physical therapist, aimed at helping you move and do more with neck or back pain.

  • Staying active and walking

    Keeping up everyday activities as comfortably as you can, often with a gradual walking plan, instead of resting in bed.

  • Yoga, tai chi and Pilates

    Mind-body exercise that pairs gentle movement with breathing and focus, with small to modest benefits on average for long-lasting low back pain.

Hands-on care

Massage

Massage can ease muscle tension and help you relax. The relief is often short term.

  • Massage therapy

    Hands-on pressing, kneading and stretching of muscles and other soft tissues, which may ease back or neck pain for a short time.

Hands-on care

Chiropractic care

Chiropractors use hands-on techniques, including spinal manipulation, which guidelines list as one option for low back pain.

  • Chiropractic care

    Hands-on care from a chiropractor, most often spinal manipulation, which may modestly ease low back or neck pain for a while.

Complementary care

Acupuncture

Very thin needles placed through the skin. Guidelines include acupuncture as one option for low back pain.

  • Acupuncture and dry needling

    Two treatments that use very thin needles: acupuncture, from traditional Chinese medicine, and dry needling, which targets tight knots in muscles.

Complementary care

Cupping

Gentle suction cups on the skin. Cupping is popular, but there is little strong research on it so far.

  • Cupping

    Cups placed on the skin create suction that lifts the skin and the tissue below. It may ease back or neck pain for a short time, but the evidence is limited.

Medicines

Medicines applied to the skin

Creams, gels, and some patches that act mainly where you put them, with less of the medicine reaching the rest of the body than pills.

  • Topical pain relievers

    Creams, gels, sprays and patches you put on the skin over a sore spot. Some work well for sprains and strains and help some people with knee or hand arthritis, but there is little research on back and neck pain.

Medicines

Medications

Pain relievers and prescription medicines can take the edge off pain. Each one has trade-offs worth knowing about.

  • Acetaminophen

    A common pain and fever reliever that is easy on the stomach. Studies show it does little for low back pain, and too much can seriously harm the liver.

  • Anti-inflammatory pain relievers (NSAIDs)

    Medicines such as ibuprofen and naproxen that ease pain and inflammation. For low back pain they give a small, short-term benefit, and they carry stomach, kidney and heart risks.

  • Muscle relaxants

    Short-term prescription medicines for back or neck pain with muscle spasm, which on average help only a little and often cause drowsiness.

  • Gabapentin and pregabalin

    Nerve pain medicines that help some nerve conditions but have shown little or no benefit for most back pain and sciatica.

  • Antidepressants used for pain

    Some antidepressants, especially duloxetine, can turn down long-lasting pain signals, though the average benefit for back pain is small.

Procedures

Injections and procedures

For some kinds of pain, a specialist can place medicine near a nerve or joint in the spine. Relief is often temporary, and some clinicians use it as a window to move more.

  • Epidural steroid injections

    A shot of anti-inflammatory medicine placed near irritated spinal nerves, most often for pain that travels down an arm or a leg.

  • Facet joint injections and medial branch blocks

    Numbing medicine, sometimes with a steroid, placed at the small joints at the back of the spine, mostly as a test of whether those joints are a main source of neck or back pain.

  • Radiofrequency ablation

    A procedure that uses heat to stop small nerves from sending pain signals from certain spine joints, usually offered after test blocks suggest those joints are a main source of pain.

  • SI joint injections

    An injection of numbing medicine, often with a steroid, into the joint where the spine meets the pelvis, used as a test of whether that joint is a main source of pain and sometimes as a treatment.

Support

Bracing

Braces and collars can give short-term support. Getting back to moving freely is an important part of recovery for most people.

  • Back braces and neck collars

    Belts, corsets and collars worn to support the low back or neck, which may feel comforting for a while but show little clear benefit in studies for most back and neck pain.

Everyday health

Lifestyle

Weight and smoking are both linked with back pain. Small changes add up, and help is available.

  • Weight, smoking and your spine

    What research shows about body weight, smoking and back pain, and the kinds of support that can help people make changes at their own pace.

Where to start

Not sure where to begin? Find the warning signs, how care options can fit together, and questions to bring to your appointment.