Back pain

Written by: 
Dr Keiran Walsh

Back pain is common - so common, in fact, that nearly everyone suffers from it at some time. Whether it comes on suddenly or is a long-term problem, it can put you completely out of action for a while. The best way to overcome acuteHas a sudden onset. pain and to avoid chronicA disease of long duration generally involving slow changes. pain is to nip it in the bud once it has started.

Back pain warning signs

If you wake up with back pain, first of all be aware that there are a number of 'red flags' or serious warning signs to watch out for. If you get these as well as pain, there's a possibility of a serious underlying cause for the pain and it's best to seek help at once. Red flag signs include:

  • Weakness of one or both legs
  • Problems passing urine or stools
  • Trouble passing urine or opening your bowels
  • Back pain that travels higher up into your chest area
  • If your pain has been caused by major trauma A physical injury or emotionally painful event.(such as a fall or an accident)
  • If you have new back pain and you’re older than 50 years or younger than 20
  • You have night-time pain that prevents you from getting to sleep or that keeps you awake
  • Numbness or loss of sensation around your bottom (the ‘saddle area’)
  • Problems with walking

Even if you have just one of these signs, it's advisable to seek medical advice immediately - you may need urgent tests and treatment.

Remember: most people with back pain don’t have a serious underlying cause – even if the pain is quite severe.

Causes of back pain

Most back pain is classed as non-specificHaving a general effect. and is caused by a stressRelating to injury or concern. or strain to the back. Sometimes, the cause is one bad strain, but more usually a series of minor strains build up over time.

In some people, the pain runs down the back of the leg - a condition known as sciatica. This in itself is not necessarily a serious sign as long as the leg is not weak. Other people get arthritisInflammation of one or more joints of the body. in the bones of their back and it affects the back in the same way that arthritisInflammation of one or more joints of the body. is felt in the hands or any other part of the body. Other causes of back pain such as a fracture (due to osteoporosis or thin bones) or a tumour An abnormal swelling.(starting in the back or spreading to the back) are rare. [1]

Further examinations

If you're worried about back pain, you may need to see your doctor. You will be asked questions and examined to help find out the cause of the pain. More often than not, further tests will not be needed. Many people with back pain think they will need an X-ray, CT or MRI scan to find out the cause, but in fact these are often unhelpful. The results of these tests may be normal in people with severe pain and, conversely, can show signs of arthritisInflammation of one or more joints of the body. in people who have no pain whatsoever.

Treating back pain

In the first instance, you may need to take painkillers. Simple painkillers such as paracetamol can be effective; if these don't help, you can move on to stronger options such as non-steroidal anti-inflammatoryAny drug that suppresses inflammation drugs (NSAIDsA group of drugs that provide pain relief and reduce inflammation. ) and sometimes even stronger drugs such as codeine. Paracetamol is usually well tolerated provided you don't take too much, and NSAIDsA group of drugs that provide pain relief and reduce inflammation. can sometimes cause indigestionDiscomfort after eating. and other problems - your doctor will be able to advise you.

If the pain causes your muscles to go into spasm, your doctor may occasionally prescribe relaxants (such as a short course of diazepam) to help relax both you and your back muscles.

The painkillers should be taken round the clock initially - to get on top of and then prevent the pain. There is no point in suffering in silence. In any case, the painkillers will enable you to take the next important step in relieving the pain - getting back to your normal activities as soon as possible.[2]

Becoming mobile

Resuming your normal activities (including work if appropriate) is vital. Staying in bed will just allow the muscles in your back to become weaker and this may cause you to lose confidence. If you become bed-bound, you could be exposed to a variety of risks - including a clot in one of your legs.

It is important, as you become mobile, to go about things properly and avoid developing bad habits. If you do already have bad habits related to your back (such as slouching over your computer), now is the time to get back on track. Taking care of your posture, especially when sitting, is important (slumping in a chair, for example, throws everything out of kilter). And sitting for too long in any one position is also harmful - getting up and stretching the muscles and joints every so often will help.

Avoid lifting heavy weights for the time being, but if you can't avoid it (for example, if you have to lift children), it's important to try to put as little strain on your back as possible; bending your knees and allowing your legs to take the weight is best.

The next step

Through taking simple painkillers and becoming mobile as soon as possible, most people with back pain will get better quickly (sometimes without even going to see a doctor). But if the pain persists despite these simple measures, it's a good idea to return to your doctor to get checked out. Your doctor may advise further measures such as hot packs and physiotherapyThe use of physical therapies such as exercise, massage and manipulation..

Some people find complementary therapies such as massage or acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. helpful, but there is little hard evidence of their effectiveness.

Operations on the back are rarely needed for back pain. One possible indication that an operation is necessary is the presence of a disc or some other structure pressing on the spinal cord, but this is not common.

If your back pain continues despite all of these measures, yet it does not have a serious underlying cause, a different approach may be needed. Back pain-management programmes can be very helpful. These take a multifaceted approach, with patients receiving education, exercise and support from both experts and fellow sufferers. Such programmes usually include input from different members of a multidisciplinaryRelating to a group of healthcare professionals with different areas of specialisation. team - for example, doctors, nurses, physiotherapists, occupational therapists and sometimes psychologists (if the pain is causing significant anxiety or depression).[3]

Many people with back pain worry about the future. But it is best to try to be positive and to focus instead on getting better. Remember: most back pain improves with simple painkillers.


  1. Siemionow K, Steinmetz M, Bell G et al. Identifying serious causes of back pain: cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., infectionInvasion by organisms that may be harmful, for example bacteria or parasites., fracture. Cleve Clin J Med. 2008 Aug;75(8):557-66.
  2. Bhangle SD, Sapru S, Panush RS. Back pain made simple: an approach based on principles and evidence. Cleve Clin J Med. 2009 Jul;76(7):393-9.
  3. Wilson JF. In the clinic. Low back pain. Ann Intern Med. 2008 May 6;148(9):ITC5-1-ITC5-16.