1. Some like it hot

For some people, nothing soothes a sore back like heat. In a recent study published in the journal Spine, researchers at the University of Medicine and Dentistry of New Jersey - New Jersey Medical Center (UMDNJ-NJMC) discovered that the continuous (eight hours daily) application of low-level heat (104 degrees F) eased acute back pain better than either of two commonly used drugs, ibuprofen and acetaminophen.

Heat may be dry or moist. Dry heat sources include heat lamps, heating pads or "wearable" disposable heat packs such as ThermaCare wraps or Grabber MyCoal. Moist heat sources include warm baths and washcloths soaked in warm water. See which works best for you.

Soaking in a warm tub can be a good way to apply heat to all parts of the body at once - especially if you ache all over with fibromyalgia or if you have arthritis in several joints as well.

If you find that pain and stiffness are worst in the morning, try warm water therapy when you wake up. If pain increases through the day, a warm soak before bedtime might make it easier to get to sleep. Some people, including those in the UMDMJ-NJMC study, find that continuous heat administered by a wearable heat pack eases pain and stiffness all day.

2. Go for the cold

When back pain is severe, applying something cold can reduce pain and swelling by restricting the blood vessels and preventing fluids from leaking into the surrounding tissues. Cold therapy can also numb the affected nerves and distract your mind from the source of your pain.

But using ice for too long can cause stiffness, says Dr. Borenstein. He recommends using cold for pain associated with an injury and limiting it to the first 24 to 48 hours after pain starts. "As the process moves along, you'll want to switch to heat, which can increase blood flow to a certain degree and help movement."

Cold may be applied with a commercially available cold pack, or you can make your own cold pack by wrapping a towel around a bag of frozen peas or filling a sealable sandwich bag with ice. Judy Piette, a physical therapist in Atlanta, recommends a combination of heat and cold for her patients with painful muscle spasms. "I have them use heat for 20 minutes, do gentle exercises and then use ice for 20 minutes," she says.

For best results, and to avoid causing damage to the skin, apply cold packs for no more than 15 to 20 minutes at a time, and always put a towel between your skin and the cold pack.

If you have poor circulation, vasculitis or Raynaud's phenomenon, speak to your doctor or other health professional before applying cold therapy.

3. Get physical

If you have back pain or are recovering from surgery, physical therapy can help strengthen the muscles in your back to help relieve back pain or regain motion.

A physical therapist will custom-tailor exercises to your particular condition.

Recent research shows that exercises designed to strengthen back muscles may be useful even if you don't have back pain yet. In a recent study of 50 women between the ages of 58 and 75, those who performed back-strengthening exercises suffered fewer painful fractures of the vertebrae than women who didn't do the exercises.

4. Work out in water

You know how good it feels to soak in warm water, especially when your back is aching. It turns out that warm water may also be a good place to stretch and strengthen the muscles in your back.

By allowing your muscles to relax, warm water provides an excellent environment for those who find it difficult to exercise on land. Water acts as resistance to help build muscle strength, and the buoyancy makes it feel easier and more comfortable to exercise.

A recent study by Japanese researchers shows that exercise, whether on land or in water, improves pain levels, increases the body's production of inflammation-fighting hormones and decreases anxiety, which can exacerbate back pain.

To get a good full-body workout in the water, you'll need access to a heated pool. (Call your local Arthritis Foundation office at 800/283-7800 and ask about the Aquatics Program). You can do warm-water exercise on a smaller scale in your own tub, spa or whirlpool bath.