If you have an attack of lower-back pain that is severe, continuous and not improving, assessment and treatment by a health care professional who focuses on the back or other musculoskeletal problems may help. These practitioners may use both active and passive techniques to help you feel better. Examples of passive techniques that may be used to get you moving include:
Keep all appointments with your doctor and the laboratory. Your doctor will monitor your symptoms carefully and will probably take your blood pressure and order certain tests to check your body's response to topical diclofenac (Pennsaid, Voltaren). Be sure to tell your doctor how you are feeling so that the doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.
Cognitive Behavioral Therapy (CBT). In CBT, a psychotherapist helps you identify problematic behaviors (like becoming less active or doing fewer fun activities in response to pain), negative thoughts (about self, others and the future) and feelings (depression, guilt, anxiety). This can increase your awareness of how problematic patterns develop and help you understand the connection between thought patterns and feelings. You are then trained in pain coping skills, such as relaxation techniques, imagery, and goal setting, encouraging you to have an active role in managing and controlling pain. CBT can increase your ability to control pain while acknowledging that there may be occasionally flares beyond your control.
NSAIDs such as topical diclofenac (Pennsaid, Voltaren) may cause swelling, ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who use NSAIDs for a long time, are older in age, have poor health, smoke, or drink alcohol while using topical diclofenac. Tell your doctor if you have any of these risk factors and if you have or have ever had ulcersor bleeding in your stomach or intestines, or other bleeding disorders. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); aspirin; other NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn); oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); or serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). If you experience any of the following symptoms, stop using topical diclofenac and call your doctor: stomach pain, heartburn, vomiting a substance that is bloody or looks like coffee grounds, blood in the stool,or black and tarry stools.
A type of enzyme extracted from pineapple stems, bromelain reduces levels of prostaglandins, which are hormones that induce inflammation. Bromelain may benefit people with arthritis and conditions associated with musculoskeletal tension (such as TMJ syndrome), as well as those suffering trauma-related inflammation. What's more, the enzyme may promote healing in muscles and connective tissues.
There is a large amount of natural products on the market with anti-inflammatory properties which contain arnica, such as sports massage creams combining arnica and other natural plant extracts (devil’s claw, calendula, St John’s wort and peppermint oil, among others, as well as PHYSIORELAX FORTE PLUS cream) for symptomatic relief of joint and muscle pain. However, we must be well informed about the quality and origin of the extracts used in any creams, gels and ointments purchased at pharmacies, herbal shops and specialised phytotherapy shops, so that we use the best quality product possible.
Prolotherapy treatments work by naturally promoting a minor inflammatory response near damaged connective tissue, promoting regeneration and the growth of new, healthier tissue in the process. These treatments have been used to effectively reduce or heal chronic musculoskeletal conditions of the back, such as herniated/bulging discs, arthritis, osteoarthritis or other chronic joint pains, and tendonitis that affects the lower body and causes compensations in the spine. (7) For the most benefits, it seems that prolotherapy works best when combined with other back pain treatments, such as spinal manipulation, exercise and in some cases medications when needed.
A combination of Boswellia and curcumin showed superior efficacy and tolerability compared with nonsteroidal diclofenac for treating active osteoarthritis. Boswellia typically is given as an extract standardized to contain 30-40% boswellic acids (300-500 mg two or three times/day). Boswellia has been well tolerated in most studies, although some people may experience stomach discomfort, including nausea, acid reflux, or diarrhea.[1–10,42,48,56,62,103,104]
1. Capsaicin. Capsaicin creams and gels are made from chili peppers.  They cause a mild to moderate burning sensation thought to alter nerves' ability to interpret pain by lowering the presence of a neurotransmitter called Substance P. Brand names including Capzasin and Zostrix are marketed for arthritis, backache, and other joint and muscle pains.  These creams aren't generally associated with any adverse side effects though some patients may feel the heat more intensely than others.

Schematic showing another inflammatory pathway that is activated by tissue injury. This is the NF-kB activation, in which once the protein is free as a result of tissue injury, it can enter the cell nucleus and activate the DNA to enhance the inflammatory response further by the production of additional cytokines, chemokines, and adhesion molecules (IKKB = IkB kinase)


Arnica montana is a flowering mountain herb with a long history of traditional use in pain relief. Arnica extracts contain numerous pain reliefing ingredients, including sesquiterpene lactones, flavonoids which reduce inflammation, swelling and pain, plus thymol which fights infection. Arnica cream, gel and ointment is used to ease muscle pain and spasm, insect bites, superficial burns – including sunburn – sprains and painful joints caused by arthritis or other rheumatic disorders. Herbal arnica products contain measurable levels of active ingredients, while homeopathic arnica products contain lower levels that work in a different way. Research shows that arnica products are as effective at relieving painful joints as ibuprofen gel when applied two to four times a day.
After an injury, first rest, ice the area, use compression, and elevate the area. The acronym to help you remember is RICE. Rest the area. Ice the area 4 times a day for 10 to 15 minutes. If it looks better, compress the area with an Ace-type elastic bandage. To reduce swelling, ice helps, and so does elevating the area above your heart. When the swelling is down but you still have mild pain, apply a topical cream or gel according to the package directions. If it has worsened, consult your doctor.
Cognitive behavioral therapy can benefit your health and well being in numerous ways. It is a therapeutic technique that helps you to identify negative thoughts, emotions, and behaviors and learn how to replace them with productive alternatives. Cognitive behavioral therapy is an effective treatment for chronic pain,[15,16] as you learn to respond less to your pain and live a life less controlled by your pain.
"I love to make my own home remedy to soothe sore muscles by adding 1-2 cups of Minera Dead Sea Salt ($42; sfsalt.com) and 5-8 drops of lavender essential oils to my bath. This combination draws out toxins, calms the parasympathetic system and helps aching muscles, while easing swelling and improving blood circulation. Afterwards, I'll apply some coconut oil to soothe dry skin.' —Nikki Warren, co-founder Kaia FIT
Chondroitin sulphate is produced naturally in the body to promote the formation of healthy cartilage, tendons and ligaments, and it is also an important component of joint synovial fluid. As you get older, your joint cells secrete less and less chondroitin and this has been linked with reduced cartilage quality and the start of degenerative changes.

In a 2011 research review published in the British Journal of Anaesthesia, investigators looked at the available research on the use of topically applied capsaicin in the treatment of several types of chronic pain. This included two clinical trials examining back pain, both of which found that capsaicin helped reduce low back pain without causing notable side effects.
I have pain in booth knees from arthritis. I have used this cream for over a year. All the other pain relievers I have used, don't come close to Topricin for quick and long lasting pain relief. I use it every night and sleep like a baby. I would recommend this product to anyone that needs fast and lasting relief from pain. To me this is a God sent.
Any activity that gets your blood pumping for a sustained period will release pain-relieving endorphins into your system. The obvious problem is: How do you exercise if you're in too much pain to exercise? For many, the solution is to pick an exercise that is tolerable and start with help from a the right type of health professional, such as a physiatrist, chiropractor, or physical therapist.
The processes used to prepare herb-derived compounds pose complications when it comes to determining the quantity and concentration of the products.[30,63,102] The preparation processes are not standardized, and therefore, the extraction process and the type of plant used may affect the true concentration of the product. In addition, there is a lack of uniformity within and between manufacturers. Although dietary supplements are not held to the same rigorous testing and standards as pharmaceutically derived medications in the US, there are many regulations that still control their manufacture because these are food products.
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Many athletes and arthritis patients swear capsaicin creams reduce their pain and they love the deep warming sensation they provide. This heat may be associated with relaxation, which reduces their pain response. Researchers have concluded that capsaicin creams may reduce nerve and osteoarthritis pain in some patients (when compared to placebo), but they aren't very effective in reducing muscle pain.  Best results are achieved in joints that are close to the skin, like those in the hands or knee.

Sometimes referred to as vitamin P, citrus bioflavonoids enhance the absorption of vitamin C and act as important antioxidants. Flavonoids also inhibit collagenase and elastase, the enzymes responsible for the breakdown of connective tissue. Connective tissue breakdown is one of the factors that may cause arthritis. Flavonoids reinforce the natural structure of collagen, improve the integrity of connective tissue, protect against free radical damage and are a great natural remedy for inflammation and pain.
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It may be tempting to quit exercising when you're suffering from back pain, but it's essential to keep yourself moving. Pilates is one great option. In a 2014 European Journal of Physical Rehabilitation Medicine study, researchers found an improvement in pain, disability, and psychological health in chronic low-back pain patients who took five hourlong Pilates classes a week for six months. Meanwhile, people who remained inactive experienced further worsening of their pain. Similarly, a Medicine and Science in Sport and Exercise study revealed that taking either Pilates or a general exercise class twice a week for six weeks both improved pain and quality of life.

Cognitive behavioral therapy can benefit your health and well being in numerous ways. It is a therapeutic technique that helps you to identify negative thoughts, emotions, and behaviors and learn how to replace them with productive alternatives. Cognitive behavioral therapy is an effective treatment for chronic pain,[15,16] as you learn to respond less to your pain and live a life less controlled by your pain.
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