Back Pain: Everything You Need to Know

Back pain is the most common form of chronic pain and cause of disability in the UK. In this guide, we reveal everything you need to know about back pain, it’s causes and how to manage it.

Updated: Thursday 15 April 2021

Back pain is an extremely common health problem and the most common form of chronic pain. Up to eight in 10 people in the UK are said to be affected by back pain at some point in their lives, while 11% of all UK disabilities are attributable to back pain. This makes it the largest single cause of disability in Britain.

Back pain isn’t usually caused by anything serious, and often improves within a few weeks or months. But for some, back pain is a long-term, chronic disorder that requires constant management. And for those who have it, back pain can have a huge impact on their ability to work, socialise, exercise and generally live fulfilling lives.

Coping with chronic pain is a huge challenge. But if back pain is currently stopping you being able to live your best life, don’t give up - there are treatments and exercises that, if used correctly, can help you control it. We’ll reveal everything you need to know in our ultimate guide to treating back pain.

What are the symptoms of back pain?

This question might sound self-explanatory, but the truth is that back pain can present in a variety of ways and in different places. Back pain may present as:

• A dull ache in the lower back
• Stabbing or shooting pains that can radiate down the leg to the foot
• Being unable to stand straight without pain
• Reduced range of motion and ability to flex the back

These are the most common presentations of back pain, but it is not an exhaustive list. If you experience these symptoms or any others that cause pain in your back, it’s best to see your GP.

When is back pain ‘chronic’?

Back pain will usually go away eventually if it is strain-related, though this can take a number of weeks. In other cases, however, back pain can stay for months or longer.

Back pain is considered chronic if symptoms have been present for longer than three months. If you’ve had back pain for longer than three months, you should see your GP for further assessment and to discuss a treatment plan.

What are the causes of back pain?

In many instances, finding the cause of back pain is very difficult. Usually, back pain is classed as “non-specific”, which means no obvious cause can be identified. In other instances, pain will be classed as “mechanical”. This means the pain originates from the joints, bones or soft tissues in and around the spine.

These types of pain are usually affected by physical position and activity. So for example, you may feel better while lying down, and worse when moving around. While it’s common to feel worse while moving, it’s important to remember that you should not avoid physical activity. A sedentary lifestyle can cause muscles in the back to become weaker, which risks making the pain worse.

In cases of non-specific or mechanical back pain, symptoms can sometimes develop suddenly. While an exact cause is difficult to find, back pain is sometimes the result of poor posture or poor lifting technique - for example bending your back to pick heavy items up off the floor. That said, in many cases back pain can emerge for no apparent reason. In these cases, it’s possible stress and low mood are contributing factors.

Non-specific back pain usually starts to get better in a few weeks. If it doesn’t, you should consult your GP.

Can medical conditions cause back pain?

Yes. A variety of health problems can cause back pain, which is why it’s important that a GP investigates what could be causing it. In most cases, medical causes of back pain are usually related to spinal problems. These conditions include:

• A slipped disc, where a disc of cartilage in the spine presses on a nerve, causing back pain and possibly weakness, numbness and tingling in other parts of the body
• Sciatica, where irritation of the nerves that runs from the lower back to the feet can cause lower back pain, numbness, tingling and weakness that radiates to the buttocks, legs and feet
• Ankylosing spondylitis, where swelling of the joints in the spine causes pain and stiffness. This condition usually feels worse in the morning and gets better with movement
• Spondylolisthesis, where a bone in the spine slips out of position, causing lower back pain and stiffness, as well as numbness and tingling

These conditions are not normally serious, though they can be very painful.

In rare cases, back pain can be a sign of a serious medical problem. If you experience any of the following symptoms alongside back pain, seek medical help immediately:

• Loss of bowel or bladder control
• Fever
• Onset following trauma, such as a fall or blow to the back

Rare but serious causes of back pain include:

• A broken bone in the spine
• An infection
• Cauda equina syndrome - a condition in which the nerves in the lower back become severely compressed
• Some types of cancer, such as multiple myeloma (a type of marrow cancer)

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How can I get rid of back pain?

Like other conditions, the right treatment for back pain depends on what’s causing it. As mentioned earlier, back pain usually goes away a few weeks after it starts. However, when back pain sticks around longer than that there are some things you can try to help yourself feel better.

Stay active

The first thing to remember when you start feeling pain in your back is to keep moving. In the past, people thought the best thing for a bad back was bed rest. But we now know that those who carry on with their normal activities as much as possible are more likely to recover quicker. The reason for this is believed to be due to the fact inactivity causes muscles in the back to become weaker over time. This leaves those muscles less able to cope with the strain of everyday activity, which makes back pain worse as a result.

Instead of remaining still and relying on rest, it’s far more important to ensure you stay active. This might seem counterintuitive - and could be difficult at first - but your pain should eventually begin to subside thanks to physical activity.

Stretches and exercises

If everyday activities like walking don’t help, there are back-specific exercises and stretches you can do to relieve back pain. Your GP should be able to tell you which exercises are best, or provide you with resources so you can learn them at home. If you’re not sure where to start with back stretches, Versus Arthritis has information on which ones to do and exactly how to do them. If your back pain is severe enough, your GP might deem it necessary to refer you to a physiotherapist for further assessment.

Over-the-counter painkillers

If you’re referred to a physiotherapist for your back pain, it’s fairly likely that your doctor will also recommend painkillers to manage the condition. Back pain can often be managed with over-the-counter painkillers such as ibuprofen](https://www.pharmica.co.uk/pain-relief/ibuprofen), which works well for pain management thanks to its anti-inflammatory properties. However, ibuprofen is only supposed to be used for mild to moderate pain, and for many people it might not be enough to properly relieve the pain.

If oral medications like ibuprofen aren’t working, there are topical treatments that can provide rapid and effective relief from back pain. Voltarol, for example, is a pain relief gel that contains the active ingredient diclofenac diethylammonium - an anti-inflammatory drug that is highly effective at treating localised pain. It can be applied directly to the skin around where the pain is coming from, and used up to four times a day.

It’s important to remember that the medicine Voltarol contains is a non-steroidal anti-inflammatory drug (NSAID) - the same type as ibuprofen. For that reason, you should not take Voltarol and ibuprofen at the same time. It is, however, safe to take Voltarol with paracetamol - though you should check the patient leaflet before doing so.

Prescription painkillers

When medications like ibuprofen aren’t providing effective relief, your doctor may prescribe stronger painkillers such as codeine to manage your pain. It’s important to remember that painkillers like codeine should only be used for a few days, because they can cause addiction if taken for longer.

Therapy

In addition to painkillers and physiotherapy, if your doctor suspects your back pain is related to your mental health - for example, if you’re under a lot of stress - they may suggest psychological therapy as a form of treatment.

To be clear, this isn’t to say back pain is “all in your head” - the pain you experience is very real. However, the way you think about your condition can make a significant difference when it comes to how much back pain affects your quality of life. Talking therapies like cognitive behavioural therapy (CBT) can help keep you centred and “in the moment” when you begin to feel despondent about your back pain.

Surgery

If your pain is so severe a mixture of first-line treatments don’t help, your doctor may refer you to a surgeon to see whether your condition has a medical cause specific enough to treat with an operation. It is quite rare for back pain to be treated with surgery, and like other surgeries complications are possible.

Nerve treatment

The first form of surgery used for back pain is known as radiofrequency denervation - a form of nerve treatment that involves putting needles into the nerves that supply the joints causing your pain. Upon insertion, doctors send radio waves through the needles to heat the nerves, which stops them sending pain signals.

Radiofrequency denervation may be used if:

• You’ve had back pain for a long time
• Your pain is moderate to severe
• Your pain is thought to come from the joints in your spine

Before the procedure, you’ll be given a local anesthetic to numb your back. You’ll be awake during the operation, and will be able to go home the same day.

It’s important to remember that radiofrequency denervation does carry a risk of complications. These include:

• Bleeding
• Bruising
• Infection
• Accidental nerve damage

If you’re concerned about any of these, you should speak to your surgeon before agreeing to the procedure.

Spinal Fusion Surgery

The second kind of operation for back pain is known as spinal fusion surgery. In this procedure, surgeons fuse two vertebrae together in order to strengthen them. This can also reduce nerve-related pain caused by vertebrae squeezing the nerves passing through the spine.

Spinal fusion surgery is typically a last-resort procedure used only when there is significant damage to the bones in your back. This can be caused by a number of conditions, including:

• Lumbar degenerative disc disease - a condition where wear and tear on a spinal disk causes lower back pain
• Lumbar spondylolisthesis - a condition in which one of the bones in the spine slips forward and out of place
• Scoliosis - a sideways curvature of the spine
• Spinal fracture
• A weak spine caused by infections or tumours

Spinal fusion is typically used when back pain is so severe the person suffering it cannot function. It is a risky procedure, and can cause permanent damage to the nerves in your back. This complication happens in around one in every 200 procedures, and can lead to:

• Partial paralysis in your legs
• Bowel and urinary incontinence

If you’re concerned about these complications, you should speak to your surgeon before agreeing to the procedure.