Initial Treatment for Acute Upper Back Pain

Non-Pharmacological Management

The American College of Physicians recommends that patients with acute upper back pain remain active and continue ordinary activities within the limits permitted by pain, avoiding bed rest 3
Application of heat via heating pads or heated blankets is recommended for short-term relief of acute back pain, as suggested by the American College of Physicians 3
Medium-firm mattresses are preferable to firm mattresses for back pain relief, according to the American College of Physicians 3

The American College of Physicians recommends NSAIDs (such as ibuprofen) as first-line medication with moderate-quality evidence showing small improvement in pain intensity compared to placebo 1
Acetaminophen is an alternative first-line option with a more favorable safety profile, though it may provide slightly less pain relief than NSAIDs, as stated by the American College of Physicians 3
Skeletal muscle relaxants (SMRs) can be considered if pain persists, with moderate-quality evidence showing improved short-term pain relief after 2-7 days compared to placebo, according to the American College of Physicians 1

For elderly patients, acetaminophen may be preferred over NSAIDs due to lower risk of adverse effects, as recommended by the American Geriatrics Society 4
Systemic corticosteroids are not recommended as low-quality evidence shows no difference in pain or function compared with placebo, according to the American College of Physicians 1
Opioids should be reserved for severe, disabling pain not controlled with acetaminophen and NSAIDs, and only after carefully weighing potential benefits and harms, as stated by the American College of Physicians 3
Diagnostic imaging is not recommended unless there is suspicion of serious underlying pathology or no improvement after 6 weeks, as suggested by the American College of Physicians 2