What really works for back pain?

Back-pain sufferers are admittedly desperate and willing to try anything—shoe inserts, devices that zap them with electric pulses, or braces to wrap around their lower back. And sales of back creams, patches, and wraps amounted to nearly $1 billion last year.

But “many of these items are expensive, and research doesn’t always show that they work,” says Gerardo Miranda-Comas, M.D., an assistant professor of rehabilitation medicine at the Icahn School of Medicine at Mount Sinai in New York City. And the American College of Physicians, in its new guidelines, finds good evidence only for heating pads. Here are some things to consider before you invest in over-the-counter products.

Worth a Try

Heating Pads, Wraps, and Bottles

They cause blood vessels to dilate, which can increase blood flow to tissue and ease pain.

Cost: ThermaCare Lower Back & Hip Heatwraps, which are disposable, cost about $7; the SoftHeat Pain Relief for Whole Body Wellness Wrap, which is reusable, runs about $20. UTK far infrared Heating waist Belt, cost $79.

What experts say: A 2016 analysis in the Journal of Chiropractic Medicine found that heat wraps increase muscle temperature and blood flow to tissue, says Alan Hilibrand, M.D., a spokesman for the American Academy of Orthopaedic Surgeons and co-director of spine surgery at the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia.

CR’s take: It’s worth trying one, but don’t use it for more than 20 minutes at a time. “I’ve had patients who fall asleep with them on and as a result develop mild burns,” Hilibrand says. Never put these products over creams or patches (see below). And note that a hot-water bottle works as well.

Creams and Patches

Rub-on creams that contain capsaicin (found in chili peppers) or methyl salicylate (oil of wintergreen) create a feeling of heat. Those with menthol cause a cooling sensation. Lidocaine-based products have a numbing effect.

Cost: An over-the-counter patch that contains menthol, like the Absorbine Jr. Pain Relief Back Patch, costs about $4. A product with 4 percent lidocaine, like the Lidocare Pain Relief Patch Back/Shoulder, is about $19.

What experts say: There’s little research on OTC patches and creams, but prescription-strength versions of lidocaine and capsaicin products can help, research suggests.

CR’s take: OTC lidocaine products are your best bet because they’re closest to the prescription versions, our experts say.

Have any home remedies for back pain worked for you?

Tell us about it in the comments below.