Back pain treatment

Knowing what to expect when you seek health care can help you to get the most out it. This page describes what your healthcare provider will do and why(external link). This may include questions, tests, information, advice, or treatment.

Your healthcare provider will explore:

• What happened? How did it begin? How has it changed?
• What are your symptoms and where do you feel them?
• How does it impact on you? Sleep, movement, activity, work, sport, family, social life, sex
• What are your thoughts and concerns about your back pain?
• How do you feel? Are there other things that cause you distress?
• How is your wider health?
  • Physical and mental health – past and present.
  • Exercise, diet, sleep, smoking.
• You may be asked to complete a survey.

Your answers will help them think about what’s going on, what support you may need, where to focus their exam and explanations, what may help you recover, and how your whole health may affect your back pain.

Your healthcare provider will assess your movement and function. They will also:

• Look for signs of specific types of back pain:
  • Severe pain in your leg with certain tests.
  • Weakness, numbness, and reflex change in your leg.
  • Very limited movement and pain with tests that load certain joints.
• Look for signs of serious types of back pain:
  • Fever or local redness and heat.
  • Numbness and complete loss of muscle use.
  • A pulsing mass in your belly (puku).
  • Severe bony tenderness.

Your assessment will be used to help you move or function better and to compare with your movement in future. Specific types of back pain may be helped by certain treatments.

• In the first 6 weeks, imaging is used to rule out serious causes of back pain (less than 1 person in a 100 with back pain)
• After 6 weeks, imaging is used to confirm specific causes of back pain (about 5 people in a 100 with back pain)
• Imaging isn't helpful for most back pain (about 95 people in a 100 with back pain).

If imaging is recommended, your healthcare provider will explain which specific cause of back pain they're thinking about and how confirming this will change treatment. They will discuss the risks and benefits of the imaging itself, as well as any potential treatment, so you can decide if you would like to proceed. 

If imaging isn't recommended, your healthcare provider will explain why it won't show the reason for the pain or tell you what to do. Most imaging findings are common in people with no back pain and don't change care decisions. Seeing these findings may cause worry and lead to treatment that doesn't help. Imaging this type of back pain can slow your recovery. 

Your healthcare provider will provide a clear explanation that makes sense to you.

• This will include the likely cause of your pain and how things will progress over time.
• Most back pain (90%), while very painful and distressing is not due to something serious or tissue damage. It’s likely to get better on its own over a couple of weeks.

They will discuss your concerns and allow time to ask questions.

They will provide a clear plan of action and a written summary of:

• Any further tests that you need and why.
• Treatment options – including costs, risks, benefits (and how they know this).
• Things you can do (self-care) including how to ease your pain, exercise, physical activity, and work. Read more about self-care.
• How to access resources and support, eg, websites.

Your understanding is very important for managing back pain. It helps you to understand the likely cause of your pain and what to do. It also allows the clinician to discuss your concerns. If you have any questions or don't understand what's being discussed or suggested, let your healthcare provider know.

Your healthcare provider will want to understand:

• Your normal daily activities and work demands and how your back pain affects these to develop a plan that suits your needs.
• What types of physical activity you like. This helps them to develop a graduated plan (building up over time) that you can be confident with.

They will help you to set goals you can work towards, and coach you on how to use a self-care programme that matches your needs and puts you in control.

Keeping active and going to work is good for you. Activities may need to be modified at first. Gradually building your activity levels and work demands will help you to get back to normal life quickly. It is safe to have some pain while working or being active, but if your pain is getting worse or you are distressed it's okay to ease up.

Self-care practices are good for you. These include physical activity, relaxation, spinal movement, and looking after your whole health (eg, sleep habits, diet, and stress). Read more about self-care for back pain.

Your healthcare provider will discuss whether any medicine would be helpful for you and explain the risks and benefits so you can make an informed choice.

• They will provide a clear plan of when and how to reduce and stop the medicine. This will be combined with a self-care plan.
• They will explain what side effects to look for.

Most back pain settles quickly without medicine. Taking pain relief medicine may help you to manage your pain so you can stay active and engaged with life. Medicine can provide a short-term aid while you build your self-care strategies. However, pain medicines don't stop your pain and can be harmful if taken long-term.

Read more about medicines for back pain in the types of treatment section below. 

Keep in touch with your healthcare provider so they know how you're getting on. If you need more help or feel you're not making any progress there are other options. 

• They will discuss with you the support you need and how you can get this.
• They will interview you about your problem, including:
  • Your symptoms – what they feel like, how bad they are, and how they have changed over time.
  • The impact of your back pain on all parts of your life including how you're coping with the pain.
  • They may also ask you to repeat the survey you completed when you first saw them.
• They will fully examine you again.
• You might be referred for more tests or to see someone or a team who can help with your type of problem.

Some people need support with returning to work and to daily tasks, activity, or exercise.

Some people don't recover as expected, or their symptoms change or get worse over time, and they need further review.

Physiotherapy

One of the most common treatments for back pain is physiotherapy. Physiotherapists are able to:

• assess your back pain and confirm that your pain isn't due to anything serious
• assess movement limitations and identify the best way to address these
• identify things you're doing that may be adding to your pain
• explore ways to modify your work and other daily tasks so you can continue to do these
• teach you exercises that can help to reduce pain and prevent further episodes
• work with you to develop a plan to get you back doing everything you would like to do.

Medicines

Most back pain settles quickly without medicine. Medicines can be used to supplement other things that you are doing for back pain, but often don't provide much additional benefit and can be harmful long-term. If you are using pain relief medicine, it’s best to take it on a regular basis for 3 to 5 days, rather than using the medication only when the pain becomes unbearable.

Non-medicine treatments

There are a variety of other non-medicine-based treatment options to manage pain such as acupuncture, manipulation and massage. Before starting any treatment, talk to your doctor so that treatment options can be discussed and to ensure that a specific treatment option is suitable for you. Read more about non-medicine treatments for pain.

• A few sessions of spinal manipulation may offer some relief and improved function in people with acute low back pain.
• How we think and feel has a large impact on pain. Psychological therapies can be very helpful for helping to recover from back pain.
• Massage or yoga was found to have greatest benefit in people with chronic back pain who expected to improve with these treatments.
• Acupuncture is helpful for some people with back pain.

Injections

Occasionally an injection may be needed to help an irritated nerve to calm down. These may be indicated if your pain is worse in your leg than your back and it hasn't settled after at least 6 weeks of an active rehabilitation programme.

Surgery

Surgery is rarely needed for back pain. Outcomes for many back surgeries are no better than those for rehabilitation programmes over the medium to long-term. Your healthcare team will discuss the potential risks and benefits with you if they think surgery is an option you need to think about.

Video: Advice on managing back pain

Video: Recovery for persistent back pain – low back pain, how Joe got his life back

This video may take a few moments to load.

Video: Back stretches

This video may take a few moments to load.

What you do day-to-day is very important to help keep you healthy and prevent back pain.

• Keep active – regular exercise improves health and reduces recurrent back pain. Try to get at least 150 minutes of moderate or intense physical activity a week.
• Sleep well.
• Manage your stress and anxiety levels.
• Don’t smoke because nicotine decreases blood flow to your back. Back pain is more common and recovery is slower in smokers.
• If you have recurring back pain, the following may help:
  • exercise regularly – people who do regular exercise have less back pain than those who are inactive
  • aim for a weight within your healthy range
  • manage stress and mood
  • ask your physiotherapist or healthcare provider to explore with you the types of movements and activities that are best for you.