The most effective pain relief for lower back pain largely depends on its cause. Low back pain can arise from various factors, some of which may be physical and acute, while others may be more complex, involving lifestyle factors, concerns about pain, and the duration of the pain. It is well-established that long-term use of painkillers is not particularly effective in managing low back pain. Studies have shown that the benefits of long-term painkiller use diminish over time. In the case of opioids, their effectiveness often decreases significantly, leading to the need for higher doses, which can result in increased side effects with diminishing pain relief. Â
Understanding Pain Medication for Low Back PainÂ
The use of opioids, such as morphine and similar medications, has been strongly discouraged for long-term pain management in the UK for many years. Although opioids can be highly addictive, their effectiveness decreases over time, while side effects worsen. This is because higher doses are needed to achieve the same pain relief that smaller doses provided earlier in the treatment. However, short-term use of pain medications, including anti-inflammatories or muscle relaxants, can be helpful for reducing discomfort and improving movement during acute or short-term episodes of low back pain. It is important to discuss any medication use with a pharmacist or doctor, as it can interact with other medications you may be taking and may have side effects, particularly affecting the stomach, gastrointestinal tract, liver, and kidneys. 
Finding Relief
In very acute episodes of low back pain, warm or cold packs can be beneficial. Generally, if the pain is triggered by an injury or strain, applying a cold compress may help reduce pain and inflammation resulting from acute injury. After 24 hours, it may be useful to switch to a warm compress, as it can increase blood flow to the area and soothe nerve endings. However, if the area remains very hot and inflamed, continuing the use of cold compresses might still be advantageous. For ongoing low back pain that occurs intermittently, you can use either heat or cold compresses based on what feels most soothing. Be cautious not to make the packs too hot or too cold, as direct application of ice pack or very hot wheat bags can cause burns or alter the skin, potentially leading to additional pain. Â
Movement Strategies for Managing Low Back Pain
One of the best ways to address acute or chronic low back pain is to find a comfortable position to sit or lie in during the initial acute stages. As soon as possible, begin incorporating regular movement within the limits of your pain to prevent the spinal joints from becoming too stiff or restricted and to keep the muscles flexible. Once you can move with less pain, regular gentle but progressive movement becomes crucial. As your symptoms improve, gradually increase both the range of motion and the frequency of your movements. Walking is a well-researched and effective option for improving back pain symptoms, so don’t hesitate to go for regular short walks and gradually increase the distance as your pain allows.  
When to Seek Help
If symptoms do not improve, or if they persist at a significant or severe level after three or four days, it is advisable to seek professional advice and assessment from a qualified musculoskeletal physiotherapist.
If you have other concerning symptoms, consult your GP or general practice clinical staff. However, if your symptoms are gradually improving, it’s likely that continued progressive movement will help. In most cases, back pain naturally subsides over time without the need for medication or additional interventions. 
Author – Phin Robinson, Founder & Director of Pure Physiotherapy.Â
Pure Physiotherapy can support you with any musculoskeletal concerns you may have. Our clinics located throughout the UK are here to help.