Back pain

If you have back pain, you are not alone. It is a very common problem that many people experience at some point in their lives. For most people, back pain comes on quickly but then improves or goes away within 3 to 6 weeks. This is called acute back pain.

It is also common for back pain to come back, and some people go on to develop more persistent pain that lasts longer than 3 months. Back pain can affect every part of life, including daily activities, family life, work, recreation and social activities. The good news is that there is a lot you and your healthcare team can do to manage it so you can get on with life.

How your back works#

To understand your back pain, it helps to know a little about how your back works.

Your backbone (spine or spinal column) is made up of bones called vertebrae, stacked on top of each other to form an “S”-shaped column. The spinal cord, which carries messages between the brain and the rest of the body, runs down a bony tunnel behind the vertebrae, where it is protected from damage.

Each vertebra is cushioned by spongy tissue called intervertebral discs, which act as shock absorbers. The vertebrae are joined by small joints (facet joints) that let them slide against each other, allowing you to twist and turn. Tough, flexible bands of soft tissue (ligaments) hold the spine in position, and layers of muscle provide support and help you move, joined to bone by strong tissues (tendons).

The structures and soft tissues in your back are tough, flexible, and designed to move, carry weight and support you.

Signs and symptoms#

Back pain may be felt anywhere along the spine, from the neck to the buttocks. In some cases, pain may also be felt in one or both legs.

While you have back pain it is common to be a little restricted in daily activities such as bending, lifting, sitting and walking. Movement of your torso may be limited, and there may be tenderness when pressure is applied to the joints of the spine. Reduced reflexes, strength or sensation in the legs can be a sign of nerve compression.

It is also common for people with back pain to feel distressed about their recovery.

Causes of back pain#

In most cases (around 90% to 95%), the cause of back pain is unknown. This is called non-specific back pain, which means it is not caused by a specific condition, illness or serious damage to the back. Non-specific back pain may be triggered by things such as a sudden or unusual increase in load on the spine, for example having to lift and carry a sick child more than usual.

Back pain with a specific cause is less common. It can include things such as a herniated (bulging) disc, where the intervertebral disc becomes weakened and bulges, sometimes pressing on nerves, although it does not actually “slip” or move out of place.

In a very small number of people (less than 1%), back problems are caused by a serious condition. Signs to be aware of include:

• Severe pain that gets worse over time instead of better
• Feeling generally unwell, or having a fever, with your back pain
• Problems controlling your bladder or bowel
• Numbness or pins-and-needles in your legs, between your legs, or in your feet
• Weakness in your legs or unsteadiness on your feet
• Redness or swelling on your back
• Unexplained weight loss

If you experience any of these symptoms, contact your doctor promptly.

There is no evidence that back pain is caused by everyday lifting and bending.

Diagnosing back pain#

If back pain is affecting your life, see your doctor for help. Your doctor or healthcare clinician will:

• Ask about your back pain, including possible causes or triggers, whether you have had it before, and how it affects you
• Ask about any other symptoms or health issues
• Do a thorough physical examination

Your doctor may refer you for tests if they think there could be a more serious cause. However, in most cases of back pain, imaging such as x-rays, CT or MRI scans is not useful and is not recommended, because these scans are not good at identifying the cause of pain. Your doctor’s examination will decide whether further investigations are likely to be helpful in developing a treatment plan that is right for you.

It is important to know that many investigations show “changes” in the spine that are normal signs of ageing rather than damage.

Treating back pain#

Most people recover quickly from acute back pain, whether they seek treatment or manage it themselves. For more persistent pain, effective treatments include:

• Supervised exercise therapy with a qualified health professional, such as a physiotherapist or exercise physiologist
• Cognitive behavior therapy (CBT), which involves working with a mental health professional to change unhelpful patterns of thinking and behaving
• Multidisciplinary pain management, involving a team that may include specialist pain physicians, physiotherapists, occupational therapists and psychologists
• Some medications

Surgery is rarely needed for back pain unless a more serious problem is causing it, or if nerve compression is present.

When it comes to medication, paracetamol has been shown to have no effect on back pain. Over-the-counter pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) may be used. Opioids have commonly been prescribed for back pain, but there is no evidence that they work better than NSAIDs for acute back pain. They also carry a high risk of serious side effects and the potential to cause harm.

Self-management and recovery#

Almost everyone has back pain at some stage of life, and most people recover quickly with little or no treatment. The best approach involves staying active and at work whenever possible, and staying positive about recovery.

Even for people with recurrent or persistent back pain, the most effective treatments involve things you can do yourself, such as:

• Learning more about your back pain: what makes it better and what makes it worse
• Exercising and staying active as much as possible; talk with a physiotherapist or exercise physiologist if you need specific advice
• Managing your stress and looking after your mental health
• Managing your weight, to lessen the strain on your back
• Getting up and moving if you have been sitting or standing in one position; take regular breaks to stretch and move around
• Staying involved in your usual home, leisure and social activities, as social connections are very important to recovery
• Quitting smoking, as smoking increases your chances of developing back pain
• Staying at work where possible, and developing a return-to-work plan with your employer; your doctor, physiotherapist and occupational therapist can help
• Lifting and carrying safely: when picking up a heavy load, squat down, hold the object as close to your body as practical, keep your back straight and lift using your legs; get help from another person or use equipment such as a trolley if the load is too heavy
• Relaxing: learn some relaxation techniques to reduce stress and muscle tension, and try massage, heat or cold packs and gentle exercise

In most cases, acute back pain gets better within 3 to 6 weeks. Some people develop recurrent or persistent back pain, but working with your healthcare team and using self-management techniques leads to the best outcomes. Even with persistent back pain, most people are able to stay at work and lead a full life.

Key points#

• Back pain is very common, and most acute back pain improves within 3 to 6 weeks.
• In most cases (around 90% to 95%), the cause is unknown; this is non-specific back pain.
• Back pain with a specific cause is less common, and a serious cause is rare (less than 1%).
• Imaging is usually not helpful and not recommended for most back pain.
• Staying active, staying at work where possible and self-management are the most effective ways to recover.

Where to get help#