Relief for Low Back Pain with Rheumatoid Arthritis

When persistent low back pain affects everyday activities, relieving symptoms is a priority. People who also have rheumatoid arthritis will want to try treatments that do not exacerbate RA joint pain or interfere with their prescription medications.

Most first-line treatments for relieving low back pain can be done at home. Many of these strategies are also recommended for rheumatoid arthritis, so they may help reduce RA joint inflammation and fatigue in addition to low back pain.

Certain treatments offer immediate, short-term relief of low back pain while others address the underlying causes and may provide longer-term relief. The goals are to be able to work, participate in hobbies, and rest comfortably.

Immediate Relief for Low Back Pain with RA

There are several ways to get fast, temporary relief for an aching low back. These treatments are considered generally safe for people with rheumatoid arthritis.

Periodic rest

Anyone with RA is accustomed to a little joint pain, particularly in the morning as stiff joints loosen up. However, when low back pain is moderate to severe, the muscles and joints of the spine probably need rest. When pain is extreme, 1 to 2 days of rest may be necessary.

Warm and cold therapy

Applying a warming pad for 10 to 20 minutes may loosen the muscles of the back and improve the range of motion. Alternatively, taking a warm shower or bath may ease stiffness in the low back as well as joints affected by RA.

See Applying Heat vs. Cold to an Arthritic Joint

If low back pain occurs after activity, such as prolonged standing or exercise, try icing the low back for 10 to 20 minutes to decrease pain and swelling.

Topical medications

Like warm and cold therapy, topical medications can provide temporary relief from low back pain. There are several different kinds of pain-relieving creams, balms, gels, and patches that can be applied to the skin over the lower back. These products may contain:

• Counterirritants, which work by creating temporary hot or cold sensations that distract the brain and interrupt pain signals
• Salicylates, which deliver a small dose of anti-inflammatory medication that is chemically similar to aspirin
• Capsaicin, which works as a counterirritant and may also help interrupt pain signals.
• Anesthetics, such as lidocaine, which numb the area treated
• Cannabidiol (CBD) infused creams, balms, and gels, which may reduce inflammatory and neuropathic pain

Over-the-counter topical medications are generally considered safer than oral medications. However, topical medications are usually absorbed through the skin and enter the bloodstream, so side effects and interactions with other medications are possible. A pharmacist or physician can help address concerns.

Do not use topicals and hot or cold therapy at the same time:

• Combining hot and cold therapy and topical medications can lead to skin damage
• Hot and cold therapy can affect the absorption of topical medications

Read more about topical pain relievers, including prescription pain relievers.

Longer-Term Relief for Low Back Pain with RA

Changing one or more lifestyle habits can go a long way toward easing low back pain. Making a few simple changes may relieve low back pain, improve function, and have a positive effect on RA symptoms as well.

Actively manage RA disease activity

Low back pain is less likely to develop when rheumatoid arthritis is well managed. Patients are advised to take medications as scheduled and work with physicians to increase dosage or change medications that are not working well.

Research suggests that the treat-to-target approach to rheumatoid arthritis treatment may be the best way to manage disease activity. ¹ Drosos, A.A., Pelechas, E. & Voulgari, P.V. Treatment strategies are more important than drugs in the management of rheumatoid arthritis. Clin Rheumatol 39, 1363–1368 (2020). https://doi.org/10.1007/s10067-020-05001-x

Lose excess weight

Carrying extra weight increases the likelihood of back pain developing. This is true for everyone, both with ² Miura K, Morita O, Hirano T, Watanabe K, Fujisawa J, Kondo N, Netsu T, Hanyu T, Shobugawa Y, Endo N. Prevalence of and factors associated with dysfunctional low back pain in patients with rheumatoid arthritis. Eur Spine J. 2019 May;28(5):976-982. doi: 10.1007/s00586-019-05938-x. Epub 2019 Mar 8. PMID: 30850879. and without rheumatoid arthritis. Losing excess weight will take strain off the spine and may slow down or even prevent future back problems.

Dietary changes are typically necessary to lose excess weight. A high-fiber, plant-based diet that emphasizes eating fruits and vegetables may help decrease weight as well as inflammation. ³ Ning H, Van Horn L, Shay CM, Lloyd-Jones DM. Associations of dietary fiber intake with long-term predicted cardiovascular disease risk and C-reactive protein levels (from the National Health and Nutrition Examination Survey Data [2005-2010]). Am J Cardiol. 2014 Jan 15;113(2):287-91. PMCID: PMC1456807 doi: 10.1016/j.amjcard.2013.09.020. ^{, 4} Ma Y, Griffith JA, Chasan-Taber L, Olendzki BC, Jackson E, Stanek EJ 3rd, Li W, Pagoto SL, Hafner AR, Ockene IS. Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr. 2006 Apr;83(4):760-6. PMCID: PMC1456807 doi: 10.1093/ajcn/83.4.760. PMID: 16600925 ^{, 5} Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients. 2020 May 18;12(5):1456. doi: 10.3390/nu12051456. PMID: 32443535; PMCID: PMC7284442. ^{, 6} Vadell AKE, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. Am J Clin Nutr. 2020 Jun 1;111(6):1203-1213. doi: 10.1093/ajcn/nqaa019. PMID: 32055820; PMCID: PMC7266686. Exercise can also help manage weight.

See What Are Anti-Inflammatory Foods?

Avoid activities that put unwanted stress on the lower spine

It's best to avoid movements that aggravate the joints in the low back. Examples of movements that may result in pain include, but are not limited to:

• Heavy lifting, including carrying heavy bags or backpacks
• Deep bending at the waist
• Significant twisting of the torso

If these movements are done, they should be done slowly and with caution.

Improve posture

Taking steps to improve posture can improve spinal alignment and reduce low back pain. Improved posture can also reduce the risk of vertebral fractures, which can cause back pain or make it worse. ¹⁰ Baykara RA, Bozgeyik Z, Akgul O, Ozgocmen S. Low back pain in patients with rheumatoid arthritis: clinical characteristics and impact of low back pain on functional ability and health related quality of life. J Back Musculoskelet Rehabil. 2013;26(4):367-74. doi: 10.3233/BMR-130393. PMID: 23948822.

A physician or physical therapist can provide exercises and tips for improving posture.

Strengthen core muscles

Physical therapy and regular exercise may reduce low back pain and prevent it from getting worse. Stretching and strengthening the muscles in the low back can ease pressure on the spine’s joints and intervertebral discs. As the core muscles get stronger and the spine is better supported, symptoms may lessen or go away completely.

Getting regular exercise is also encouraged for managing RA. Safe, regular exercise supports joint health and—perhaps surprisingly—may decrease the chronic fatigue linked to RA. ⁷ Rongen-van Dartel SA, Repping-Wuts H, Flendrie M, Bleijenberg G, Metsios GS, van den Hout WB, van den Ende CH, Neuberger G, Reid A, van Riel PL, Fransen J. Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis. Arthritis Care Res (Hoboken). 2015 Aug;67(8):1054-62. DOI: 10.1002/acr.22561 ^{, 8} Kelley GA, Kelley KS, Callahan LF. Aerobic Exercise and Fatigue in Rheumatoid Arthritis Participants: A Meta-Analysis Using the Minimal Important Difference Approach. Arthritis Care Res (Hoboken). 2018 Dec;70(12):1735-1739. DOI: 10.1002/acr.23570 ^{, 9} Katz P, Margaretten M, Gregorich S, Trupin L. Physical Activity to Reduce Fatigue in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2018 Jan;70(1):1-10. Epub 2017 Dec 6. PMID: 28378441. DOI: 10.1002/acr.23230

These suggested treatments can be used alone or in combination to help decrease pain and increase low back function.

Getting a Diagnosis for Back Pain

The best way to know for sure what is causing low back pain is to see a medical doctor for an accurate diagnosis and treatment recommendations. Consult a physician if low back pain persists for more than a few weeks or if the pain is severe. While rare, back pain may be an early indicator of a more serious medical condition.

Diagnostic evaluations can be done by primary care physicians as well as orthopedists, physiatrists, osteopaths, and rheumatologists.

Depending on the cause and severity of low back pain, a doctor may suggest nonsurgical treatments, such as physical therapy, pain-relieving medications, and/or activity modification. Sometimes, minimally invasive procedures such as epidural steroid injections may be advised. Surgery is rarely recommended unless other treatment options have been exhausted.

Read more about Causes of Lower Back Pain on Spine-health.com