Overview

Back pain is very common and normally improves within a few weeks or months.

Pain in the lower back (lumbago) is particularly common, although it can be felt anywhere along the spine – from the neck down to the hips.

In most cases the pain isn't caused by anything serious and will usually get better over time.

There are things you can do to help relieve it. But sometimes the pain can last a long time or keep coming back.

How to relieve back pain

The following tips may help reduce your backache and speed up your recovery:

• stay as active as possible and try to continue your daily activities – this is one of the most important things you can do, as resting for long periods is likely to make the pain worse
• try exercises and stretches for back pain; other activities such as walking, swimming, yoga and pilates may also be helpful
• take anti-inflammatory painkillers, such as ibuprofen – remember to check the medicine is safe for you to take first and ask a pharmacist if you're not sure
• use hot or cold compression packs for short-term relief – you can buy these from your local pharmacy, or a hot water bottle and a bag of frozen vegetables wrapped in a cloth will work just as well

Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better, as people who manage to stay positive despite their pain tend to recover quicker.

Getting help and advice

Back pain usually gets better on its own within a few weeks or months and you may not need to see a doctor or other healthcare professional.

But it's a good idea to get help if:

• the pain doesn't start to improve within a few weeks
• the pain stops you doing your day-to-day activities
• the pain is very severe or gets worse over time
• you're worried about the pain or are struggling to cope

Back Pain is one of the conditions covered by the Common Ailments Scheme which is an NHS service that patients can access for free advice and free treatment and is available from 99% of pharmacies in Wales. 
Find your nearest pharmacy. 
Find out more information on the service. 
 
If you see your GP, who will ask about your symptoms, examine your back, and discuss possible treatments, they may refer you to a specialist doctor or a physiotherapist for further help. 

Read more about how to find a physiotherapist.

Treatments from a specialist

Your GP, specialist or physiotherapist may recommend extra treatments if they don't think your pain will improve with self-help measures alone.

These may include:

• group exercise classes – where you're taught exercises to strengthen your muscles and improve your posture
• manual therapy – treatments such as manipulating the spine and massage, usually carried out by physiotherapists, chiropractors or osteopaths
• psychological support, such as cognitive behavioural therapy (CBT) – this can be a useful part of treatment if you're struggling to cope with the pain

Some people choose to see a therapist for manual therapy without seeing their GP first. If you want to do this, you'll usually need to pay for private treatment.

Surgery is generally only considered in the small number of cases where back pain is caused by a specific medical condition.

Causes of back pain

It's often not possible to identify the cause of back pain. Doctors call this "non-specific" back pain.

Sometimes, the pain may be a result of an injury such as a sprain or strain, but often it occurs for no apparent reason. It's very rarely caused by anything serious.

Occasionally back pain can be due to a medical condition such as:

• a slipped (prolapsed) disc – where a disc of cartilage in the spine presses on a nearby nerve
• sciatica – irritation of the nerve that runs from the pelvis to the feet

These conditions tend to cause additional symptoms – such as numbness, weakness or a tingling sensation – and they're treated differently to non-specific back pain.

Preventing back pain

It's difficult to prevent back pain, but the following tips may help reduce your risk:

• do regular back exercises and stretches – your GP or a physiotherapist may be able to advise you about exercises to try
• stay active – doing regular exercise can help keep your back strong; adults are advised to do 150 minutes of exercise a week
• avoid sitting for too long when driving or at work
• take care when lifting
• check your posture when sitting, using computers and watching television
• ensure the mattress on your bed supports you properly
• lose weight through a combination of a healthy diet and regular exercise if you're overweight – being overweight can increase your risk of developing back pain

When to get immediate medical advice

You should contact a GP or 111 immediately if you have back pain and:

• numbness or tingling around your genitals or buttocks
• difficulty peeing
• loss of bladder or bowel control - peeing or pooing yourself
• chest pain
• a high temperature
• unintentional weight loss
• a swelling or a deformity in your back
• it does not improve after resting or is worse at night
• it started after a serious accident, such as after a car accident
• the pain is so bad you're having problems sleeping
• pain is made worse when sneezing, coughing or pooing
• the pain is coming from the top of your back, between your shoulders, rather than your lower back

These problems could be a sign of something more serious and need to be checked urgently.

Who can get it

It's not always possible to identify the cause of back pain but it’s rarely anything serious.

Most back pain is what's known as "non-specific" (there's no obvious cause) or "mechanical" (the pain originates from the joints, bones or soft tissues in and around the spine).

This type of back pain:

• tends to get better or worse depending on your position – for example, it may feel better when sitting or lying down
• often feels worse when moving – but it's not a good idea to avoid moving your back completely, as this can make things worse
• can develop suddenly or gradually
• is sometimes the result of poor posture or lifting something awkwardly, but often occurs for no apparent reason
• may be due to a minor injury such as sprain (pulled ligament) or strain (pulled muscle)
• can be associated with feeling stressed or run down
• will usually start to get better within a few weeks

Medical conditions that cause back pain

Conditions that can cause back pain include:

• a slipped (prolapsed) disc (a disc of cartilage in the spine pressing on a nerve) – this can cause back pain and numbness, tingling and weakness in other parts of the body
• sciatica (irritation of the nerve that runs from the lower back to the feet) – this can cause pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet
• ankylosing spondylitis (swelling of the joints in the spine) – this causes pain and stiffness that's usually worse in the morning and improves with movement
• spondylolisthesis (a bone in the spine slipping out of position) – this can cause lower back pain and stiffness, as well as numbness and a tingling sensation

These conditions are treated differently to non-specific back pain.

Very rarely, back pain can be a sign of a serious problem such as:

• a broken bone in the spine
• an infection
• cauda equina syndrome (where the nerves in the lower back become severely compressed)
• somes types of cancer, such as multiple myeloma (a type of bone marrow cancer)

If you see your GP with back pain, they will look for signs of these.

Treatment

Back pain will usually improve within a few weeks or months. There are several things you can try to help reduce your pain in the meantime.

There are also some specialist treatments that may be recommended if it's thought simple measures aren't likely to be effective on their own.

See your GP or a physiotherapist if your pain isn't improving despite trying simple treatments.

Treatments you can try yourself

Stay Active

One of the most important things you can do is to keep moving and continue with your normal activities as much as possible.

It used to be thought that bed rest would help you recover from a bad back, but it's now recognised that people who remain active are likely to recover more quickly.

This may be difficult at first, but don't be discouraged – your pain will start to improve eventually. Consider taking painkillers if the pain is stopping you from carrying on as normal.

There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity and it can distract you from the pain.

Back exercises and stretches

Simple back exercises and stretches can often help reduce back pain. These can be carried out at home as often as you need to.

For information about the types of exercises and stretches that can help, see:

• Versus Arthritis: exercises to manage back pain

A GP may be able to provide information about back exercises if you're unsure what to try, or you may want to consider seeing a physiotherapist for advice.

Doing regular exercise alongside these stretches can also help keep your back strong and healthy. Activities such as walking, swimming, yoga and pilates are popular choices.

Painkillers

Non-steroidal anti-inflammatory drug (NSAIDs) tablets, such as ibuprofen can help relieve back pain. Many types are available to buy from pharmacies or supermarkets without a prescription.

But NSAIDs aren't suitable for everyone, so check the box or leaflet to see whether you can take the medicine first. Speak to a pharmacist if you're not sure.

If you can't take NSAIDs, alternative medicines such as codeine may help. This is a stronger painkiller that should ideally only be used for a few days, as it can cause addiction if used for longer.

Paracetamol on its own isn't recommended for back pain, but it may be used alongside stronger painkillers such as codeine.

Muscle relaxants may be prescribed by your GP if you have painful muscle spasms in your back.

Some muscle relaxants such as diazepam can make you feel drowsy, dizzy or caused blurred vision. Do not drive, cycle or operate machinery if you have these types of side effects.

Hot and cold packs

Some people find that heat - for example, a hot bath or a hot water bottle placed on the affected area - helps ease the pain when back pain first starts.

Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area can also help in the short-term. However, do not put the ice directly on to your skin, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth first.

Another option is to alternate between hot and cold using ice packs and a hot water bottle. Hot and cold compression packs can be bought at most pharmacies.

Relax and stay positive

Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition may make things worse.

Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better, as people who manage to stay positive despite their pain tend to recover quicker.

Specialist treatments

Exercise classes

A GP may suggest attending an NHS group exercise programme if they think it might help reduce your pain.

These programmes involve classes led by a qualified instructor, where you're taught a mix of exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.

Manual therapy

Manual therapy is the name for a group of treatments where a therapist uses their hands to move, massage and apply careful force to the muscles, bones and joints in and around your spine.

It's usually carried out by chiropractors, osteopaths or physiotherapists, although chiropractic and osteopathy aren't widely available on the NHS.

Manual therapy can help reduce back pain, but it should only be used alongside other measures such as exercise.

There's also some evidence that a therapy called the Alexander technique may help with long-term back pain, although the National Institute for Health and Care Excellence (NICE) doesn't currently recommend this treatment specifically.

Psychological support

A GP may suggest psychological therapy, in addition to other treatments such as exercise and manual therapy.

Therapies such as Cognitive behavioural therapy (CBT) can help you manage your back pain better by changing how you think about your condition.

While the pain in your back is very real, how you think and feel about your condition can make it worse.

If you've been in pain for a long time, a specialist treatment programme that involves a combination of group therapy, exercises, relaxation, and education about pain and the psychology of pain may be offered.

Surgery and procedures

Surgery for back pain is usually only recommended if there's a specific medical reason for your pain, such as sciatica or a slipped (prolapsed) disc, and other treatments haven't helped.

Nerve treatment

A procedure called radiofrequency denervation may sometimes be used if:

• you've had back pain for a long time
• your pain is moderate or severe
• your pain is thought to originate from the joints in your spine

This procedure involves inserting needles into the nerves that supply the affected joints. Radio waves are sent through the needles to heat the nerves, which stops them from sending pain signals.

You're awake while the treatment is carried out and local anaesthetic is used to numb your back. You won't need to stay in hospital overnight.

As with all procedures, radiofrequency denervation carries a risk of complications, including bleeding, bruising, infection and accidental nerve damage. Discuss the risks with your surgeon before agreeing to treatment.

Spinal fusion surgery

Spinal fusion surgery is another type of surgery for back pain. It may be recommended if there's significant damage to the bones in your back (vertebrae).

Spinal fusion surgery can be used to fuse 2 vertebrae together to strengthen them. This can also help to reduce any related nerve pain as it stops the damaged vertebrae squeezing the nerves that pass through the spine.

It's possible that this type of surgery could cause permanent damage to some of the nerves in your back. This may lead to some partial paralysis in your legs and bowel or urinary incontinence. This complication is estimated to happen in around 1 in every 200 procedures.

Treatments not recommended

A number of other treatments have sometimes been used for non-specific back pain (back pain with no identified cause) but are not recommended by the National Institute for Health and Care Excellence (NICE) because of a lack of evidence.

These include:

• belts, corsets, foot orthotics and shoes with "rocker" soles
• traction - the use of weights, ropes and pulleys to apply force to tissues around the spine
• acupuncture - a treatment where fine needles are inserted at different points in the body
• therapeutic ultrasound - where sound waves are directed at your back to accerlerate healing and encourage tissue repair
• transcutaneous electrical nerve stimulation (TENS) – where a machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) attached to your skin
• percutaneous electrical nerve stimulation (PENS) – where electrical pulses are passed along needles inserted near the nerves in the back
• interferential therapy (IFT) – where a device is used to pass an electrical current through your back to try to accelerate healing
• painkilling spinal injections (although these can help if you have sciatica)