I fell on my lower back today. i'm on the couch taking carisoprodol (from a previous muscle spasm). i'm still in spasm and it really hurts.

I would advise an : Er visit if you can't get a doctors visit at this hour, you may have a fracture of your spine.

See your Doc: See your doc or got to an er to ensure you don't have fx , if your symptoms are not improving over next 2-3 days. Pain meds and the muscle relaxer would be needed, along with a ice pack for a few days, then a hot pack. Its better to get it checked out, to be safe and to get it treated early and properly.

See a pain specialis: Recommend seeing a pain specialist(they are usually anesthesiologists in terms of training background); he/she can give you lumbar epidural steroids. You should also get physical therapy if you haven't done so yet. Acupuncture can help but it isn't covered by insurance.