My doctor tells me to stay active and get back to work despite back pain rated as an eight out of 10 on a scale from zero (no pain) to 10 (worst). How can I really do this when I’m in so much pain?

Research on low back pain (LBP) patients does suggest a “keep active” guideline as the first approach to LBP. The concern is that acute LBP will transition into chronic pain and disability. Bed rest hasn’t been proven effective, whereas patients who stay active seem to do the best.

You may need a slightly more comprehensive program of pain management. For some patients, a combination of activity, pain relievers, and behavioral changes works best. Medications to control pain and muscle spasm may be needed so that you can stay active. Ask your doctor which pain meds might work best in your case.

Fear of movement and fear of reinjury are common themes for many back pain patients. It hurts to move so you stop moving. Pretty soon you’re afraid to move because it might hurt. This cycle can tip the scales against you in terms of a quick and easy recovery.

If this is the case for you, a short course of behavioral counseling may be helpful. A physical therapist will analyze your movements and ask a series of questions. The exam is used to identify a pattern of fear avoidance behaviors (FABs). A program to reduce FABs can be very successful.