NOLAN TZOU, M.D.

Many pain specialists now say therapies such as acupuncture may help more than drugs or surgery — Blake Rivas of Hewlett has suffered from back pain since she was a teenager. In her search for relief from herniated discs, a congenital spine condition and sciatica, she underwent back surgery, took medication and received epidural injections. Nothing helped until she started acupuncture treatments three years ago.

"Sometimes the pain was so bad I was unable to get out of bed," says Rivas, a 31-year-old sales representative. "Since starting acupuncture, I'm back on my feet. I'm wearing high heels again. I feel like a million dollars."

Most will feel back pain — Back pain affects nearly everyone at some point, according to the National Institutes of Health. When the pain is constant, sufferers want a quick fix. In the past, doctors recommended pain medications, interventional techniques like nerve blocks and sometimes surgery. They still do if the pain is severe.

But more often, back pain will subside within a month or two. To speed the process, pain specialists now say less conventional approaches, such as acupuncture, exercise and mind-body therapies, may be a better alternative to traditional medical treatments.

In a study published in Health Psychology last month, researchers report that biofeedback, hypnosis, relaxation training and behavioral therapy may be more effective than drugs or surgery at reducing pain intensity and improving quality of life.

"Even if you have an anatomical problem like a herniated disk sitting on a nerve, these treatments will help you cope better with the pain," explains Dr. Carole Agin, director of the Center for Pain Management at Stony Brook Hospital.

Managing back pain is highly individualized, and sometimes there is not a definitive medical explanation for why one treatment works better than another. Acupuncture, for example, is often used to relieve pain, but many doctors still aren't sure exactly how it works.

Dr. Nolan Tzou, a pain management specialist at Huntington Hospital, says it's based on the concept that rivers of energy flow through the body. Placing needles in specific points affects how that energy flows, triggering pain relief.

But there is a physical basis behind the treatment. "It's supposed to cause the release of endorphins. Acupuncture points are sometimes close to nerves and increase blood flow," said Tzou.

It doesn't work for everybody, Tzou said. And he believes it may provide relief for some people simply because their mind is set on wanting it to.

For some, a last resort — Acupuncture was a last resort for Rivas, who was planning to undergo a second back surgery when Tzou suggested it to her. "I was really nervous when he mentioned all those needles, but after I had the first session, it was nothing. The acupuncture helps. I know it does because I feel better." Rivas says she believes using her mind to control her back pain helps, too. "I think a lot of it has to do with thinking positive."

Doctors agree that the mind plays a major role in controlling pain. "If your mind is occupied with other things, you are not going to focus on the amount of pain, or even register that you're experiencing pain," Tzou says.

Learning to tame the mind also helps reduce stress, another big factor in back pain.

"You can't separate mental stress and anxiety from muscle tension stress and anxiety," says Anthony Carey, a corrective exercise specialist and author of "The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder and Joint Pain" (Wiley, $15.95). "When we are overwhelmed with responsibilities, it increases the muscle tension in the body. Sometimes the increased stress and tension can be the proverbial straw that broke the camel's back."

Finding the right treatment — With so many treatment options available, finding the right one really depends on the individual and the cause of their problem. Back pain may stem from trauma, a spinal abnormality like joint degeneration from arthritis or osteoporosis, herniated or bulging disks or spinal stenosis. None of those abnormalities, however, are guaranteed to result in back pain.

"You can take 100 people and do a scan on their backs, and a fairly large percentage are walking around with an abnormality and don't have any back pain," Tzou says.

Back pain "usually indicates there is some potential injury to the body," he says. The root of the problem may be weak or strained back muscles and ligaments caused by too much or too little use. Poor sitting or standing posture, being overweight, improper twisting, and lifting heavy objects the wrong way can all strain muscles and lead to back pain.

That starts a self-perpetuating cycle. "If somebody has lower back pain when they sit, they contort themselves to avoid the pain, and that leads to new imbalance and movement issues," Carey says.

Some exercises can help — The key to correcting those problems can sometimes be found in exercises like Pilates and yoga. They help reduce stress and improve posture while stabilizing the spine and strengthening the core muscles that run from the diaphragm to the pelvic floor, says Geralyn Coopersmith, an exercise physiologist and author of "Fit Female: The Perfect Fitness and Nutrition Game Plan for Your Unique Body Type" (Wiley, $16.95).

The exercises also take the body through a full range of functional motion, and increase strength and flexibility in the muscles that surround the hips. "When the muscles are tight they pull the spine out of a healthy neutral position," she says.

Chris Fee, a fitness instructor from Garden City, turned to Pilates 10 years ago after years of high-impact aerobics left her with sciatic pain in her lower back and buttocks. Pilates, she says, "helped strengthen the muscles in my lower back, abdomen, and stretched my hips to create improved balance and stability in my body."

Achieving that balance is an important attribute of Pilates, says Doug Pollock, a certified instructor who owns the Pilates Studio in Locust Valley. "You get a more symmetrical body in terms of strength and flexibility."

Individualized treatment — But like every other treatment for back pain, Pollock says, Pilates exercises must be tailored to the individual.

Agin agrees. Different treatments and exercises suit different people. There are also times when more aggressive medical approaches will be required. "If you can't raise your arm or your hand is numb or you're taking missteps because you're not feeling your feet, you are not going to wish that away." If those symptoms are present, seek care from a health professional. "If you wait too long, the damage can become permanent."