Patient information from BMJ

Back pain (lower back)

Last published:Aug 06, 2021

Most of us have low back pain at some time in our lives. When it's bad, you might just feel like staying in bed. But that usually does more harm than good. Keeping active is an important part of getting better.

Here, we look at low back pain that lasts less than four weeks (called acute low back pain). You can use this information to talk to your doctor and decide which treatments are right for you.

What happens?

It's very common to have aches or pains in your lower back, but it's not normally serious and usually clears up on its own within a few weeks.

Your doctor probably won't be able to tell you exactly what is causing the pain. It could be many things, such as:

• strained muscles in your back. This can happen if you lift something heavy, for example.

• bad posture: for example, sitting or standing in a way that puts pressure on the muscles around your spine.

• wear and tear on the bones in your spine (the vertebrae). This is more likely to happen as you get older.

• damage to a disc (called a slipped disc or disc prolapse). This is not a common cause of back pain.

Most people never know the cause of their back pain. But we do know that certain things can increase your chance of back problems.

For example, you're more likely to get back pain if you do work that involves lifting or sitting still for a long time (such as driving for long distances). Being overweight can also increase your chance of getting back pain.

If you have back pain for a short time there's usually no need to have an x-ray or scan. It's not likely to show anything useful.

But if your doctor thinks your back pain might be caused by something more serious like a badly trapped nerve, an infection, or a fracture, you might need to have a CT scan or an MRI scan.

Also, you should always get medical help straight away if you

• feel numb in your bottom

• lose control over when you go to the toilet

• are unable to walk, or notice that your foot is 'dropping' or dragging when you walk.

These are signs of a more serious problem.

What are the symptoms?

The symptoms of lower back pain can vary from person to person. Your back pain may come on suddenly or gradually, and the pain may be very bad or relatively mild.

Back pain can make your day-to-day life difficult. You may find it hard to get dressed, move around, or sleep. But, however much it hurts, your back will probably get better by itself.

Most people have pain only in their back. But some people have pain down one leg as well. It could be in your groin, buttock, or thigh, or run right down to your foot.

This is caused by a nerve getting trapped or damaged. It's sometimes called sciatica because it affects the sciatic nerves, which run down your legs. You might feel some numbness or tingling. If this happens you should see your doctor.

What treatments work?

There are treatments that can help ease your back pain and keep you moving. You may need a combination of treatments.

Things you can do to help yourself

Staying active may be the last thing you feel like doing. But it can reduce your pain and help you to recover more quickly.

Staying active means carrying on with the things you usually do, including going to work, as much as you can. But you should avoid doing things that make your back pain worse, such as heavy lifting.

Doctors used to recommend staying in bed if people had a bad back. But we now know this doesn't help. If you stay in bed your joints get stiff. This makes it harder and more painful to move your back.

And if you stay in bed for a long time your muscles get weaker, so they are less able to support your spine. This can make your pain worse.

It's unlikely that staying active will do you any harm. But take care if you have severe back pain. Also, it's best to avoid heavy lifting, bending or twisting your back, or sitting for long periods of time, until the pain gets better.

To soothe your back pain, you might try applying either hot or cold temperatures to your back. For example, some people use ice packs or heating pads.

Medicines

Taking pain medicine can help reduce your back pain in the short term and help you keep active.

Doctors usually recommend trying an over-the-counter painkiller first, such as ibuprofen or another non-steroidal anti-inflammatory drug (NSAID).

Another option is paracetamol. Your doctor might also prescribe a muscle relaxant to take along with an NSAID or paracetamol.

If over-the-counter medicines don't help, your doctor may prescribe a different medicine, such as a higher dose of an NSAID.

Opioid painkillers, such as tramadol, are another option. But doctors usually prescribe opioids for only a short amount of time, as you can become dependent on them if you take them for longer periods. This means you get unpleasant symptoms if you stop taking them (withdrawal symptoms).

Spinal manipulation

Having your spine manipulated might also help reduce your back pain. It involves moving parts of your spine to adjust the small joints between the bones to relieve pain and stiffness.

You may need to have the treatment several times to help with pain while your back gets better.

Your doctor can advise you about whether this treatment is right and safe for you. If your doctor thinks that spinal manipulation might help your lower back pain, they can refer you to a physiotherapist or another trained practitioner.

Other treatments

If your back pain does not improve within a few weeks, there are other treatments you can try, including physiotherapy and back exercises. You can discuss your options with your doctor.

Many alternative treatments have also been tried for short-term low back pain. They include acupuncture, massage, yoga, and transcutaneous electrical nerve stimulation (TENS). But there is no good evidence that they work. So doctors don't recommend them.

What will happen to me?

Most back pain lasts less than two weeks, and about 9 in 10 people feel better within six weeks.

Many people who have had an episode of back pain will have it again. You can talk to your doctor about ways to reduce your chance of future back pain. Exericising regularly often helps.

If your pain lasts more than 12 weeks you may find it harder to recover. You may need additional treatments, such as a talking treatment called cognitive behaviour therapy (CBT), other medicines, and possibly surgery.

You should see your doctor if your back pain isn't getting better. He or she may refer you to a specialist in back problems.