What intervention gives sustained improvement in long-standing back pain?  The intervention that showed a greater than 30% reduction in back pain was exercise. 

Patients may have trialed opioids or non-steroidal anti-inflammatory pills, but those are routinely not given for long.  A 2020 systematic review of 25 randomized controlled trials (with over 2,400 patients!) found that if you have low back pain for 12 months or more, epidural steroid injections do not give long-term meaningful improvement. Yes, epidural injections may be more effective than placebo in the short-term, but not in the long term.

Other interventions that help are osteopathic manipulation and topical capsaicin cream. Physical therapists are a great resource for initiating back exercises and confirming that your technique is correct.  Then, you can continue the therapist’s exercises as your “homework.”