Q. What works for low-back pain?

A. First off, see your doctor if you have retention or incontinence of urine, numbness in your perineal area (where you'd sit on a saddle), leg or foot weakness, previous cancer, unexplained weight loss, pain awakening you the second part of the night, IV drug use, or pain lasting more than a month.

But with normal back strain, even with severe pain, there's a high chance you'll be a lot better within 30 days no matter what you do, even with a pinched nerve (sciatica) causing leg pain from a bulging herniated disc. So pain pills such as acetaminophen — or even stronger, ibuprofen or naproxen — may be all you need. Try heating pads or heated blankets. While muscle relaxants may reduce pain, they also cause drowsiness, dizziness or nausea.

A systematic review in April 2007 by the highly regarded Cochrane group found that traction doesn't work. Steroid pills likewise don't work for back pain or sciatica. It's unknown whether lumbar supports like corsets do any good — they may decondition and weaken your back muscles, causing pain to return. But chiropractic treatment is likely to be beneficial, though a systematic review of 39 randomized studies by the Cochrane group found it no better than other standard treatments such as pain pills, physical therapy, exercises or back school. In folks with sciatica with severe herniation, it's possible that spinal manipulation may worsen the herniation.

Contrary to what you may think, avoid bed rest — systematic reviews have found that staying active is healing and actually reduces sick leave and chronic disability!

Although not shown to be effective early on, if pain lasts more than three months, then back schools, acupuncture, tricyclic antidepressants, behavioral therapy, massage and exercise therapy all reduce pain.

Do exercises that strengthen both your stomach and back, and stay active — walking and even jogging when your back improves strengthens the muscles that support the spine and prevents future back pain, but only if you keep active. Use medium-firm mattresses instead of firm ones. It's unclear if TENS (transcutaneous electrical nerve stimulation) works, and facet joint injections don't.

For sciatica, what about discectomy — surgical removal of part of the disc, or microdiscectomy? Per the Cochrane group, both provide faster relief from the acute attack than standard treatment in carefully selected patients, though any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. The evidence on other minimally invasive techniques remains unclear.

Remember — to reduce future attacks of back pain, keep active doing things like extra walking, elliptical workouts or dancing to keep your trunk muscles strong.

Dr. Landis Lum is a familypractice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; island life@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.