Keep yourself calm. Stress and the negative emotions associated with it can contribute to back pain, according to John Sarno, M.D., professor of rehabilitative medicine at the New York University School of Medicine in New York City. In particular, stress triggers the fight-or-flight response, a series of physical changes that prime your body for self-defense. Among these changes is the redirection of oxygen- and nutrient­rich blood to your arms and legs and away from your back. So if stress becomes chronic, the muscles and disks of your back can become malnourished.

At the TotalCare Medical Center in Palo Alto, California, patients with back problems learn biofeedback to manage their stress and control their pain. "We see benefit in about half of the people who try biofeedback;" says Alan P. Brauer, M.D., founder of the center. If biofeedback doesn't interest you, any relaxation technique will do. Try meditation, visualization, self-massage, or music therapy.

Herbal Medicine

Bark up the right tree. Willow bark is the original herbal pain reliever, thanks to several aspirin-like compounds it contains.

To make willow bark tea, add 2 teaspoons of powdered willow bark to 1 cup of boiling water. Simmer for 20 minutes, then strain, says Varro Tyler, Ph.D., Sc.D., distinguished professor emeritus of pharmacognosy (natural pharmacy) at Purdue University in West Lafayette, Indiana. You can drink up to three cupfuls a day. Thank heaven for devil's claw. An extract of the herb devil's claw root is a traditional folk remedy for the pain associated with musculoskeletal problems, including a bad back. You can buy devil's claw root in health food stores as an extract, powder, or tincture. Use the extract according to package directions. Or take 1 teaspoon of dried powdered root or tincture three times a day, advises Joseph Pizzorno Jr., N.D.

Chiropractic

Consult a chiropractor. Studies conducted in the United States and around the world have shown that chiropractic is often an effective treatment for back pain. For example, at the Medical College of St. Bartholemew's Hospital in London, researchers randomly assigned 741 people with back pain to receive either chiropractic or standard medical treatment. The participants completed questionnaires about their pain after 6 weeks, 6 months, and 1, 2, and 3 years. At every interval, those receiving chiropractic care reported greater improvement than those receiving standard care.

The evidence in favor of chiropractic is so persuasive that the therapy even won a ringing endorsement from an expert panel appointed by the federal Agency for Health Care Policy and Research. The panel, consisting of 21 M.D.'s and two chiropractors, made the recommendation in its 1994 report Guidelines/or Acute Lower-Back Pain. These treatment guidelines remain in effect today.