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Back pain

Back pain commonly affects your lower back. It can be a short-term problem, lasting a few days or weeks, or continue for many months or even years. Most people will have some form of back pain at some stage in their lifetime.

About back pain

Back pain is extremely common – about four in five people are affected at some point in their lifetime. You can get back pain at any age, but it's most common between the ages of 35 and 65.

Your back has many interconnecting structures, including bones, joints, muscles, ligaments, nerves and tendons. Its main support structure is the spine, which is made up of 24 separate bones called vertebrae, plus the bones of the sacrum and coccyx. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads down through the central canal of each vertebra, carrying nerves from your brain to the rest of your body.

Illustration of the different parts of the spine

It's often very difficult to know exactly what causes back pain. However, it's usually related to a strain in a muscle, tendon or ligament, or damage to one of the other structures in your back. This is known as ‘mechanical back pain’. Back pain caused by a more serious, underlying condition is unlikely unless:

  • you're over 50 or under 20 and have back pain for the first time
  • you have certain other underlying health problems
  • you have other symptoms, such as a fever or weight loss

This factsheet will focus on lower back pain.

Symptoms of back pain

If you have lower back pain, you may have tension, soreness or stiffness in your lower back area. This pain is often referred to as 'non-specific' back pain. In nine out of 10 people, it improves on its own within four to six weeks.

Back pain may be called either acute, sub-acute or chronic depending on how long your symptoms last. You may have:

  • acute back pain – lasting less than four weeks
  • sub-acute back pain – lasting four to 12 weeks
  • chronic back pain – lasting longer than 12 weeks

You should see your GP as soon as possible if, as well as back pain, you have:

  • a fever (high temperature)
  • unexplained weight loss
  • a misshapen area of spine
  • numbness or weakness in one or both legs or around your buttocks
  • loss of bladder or bowel control (incontinence)
  • constant pain, particularly at night
  • pain in more than one place on your spine

It's important to seek immediate advice from your GP about these symptoms to ensure there is no serious, underlying cause for your pain.

Causes of back pain

For most people with back pain, there is no specific problem or condition that you or your doctor can identify as the cause. This is known as non-specific lower back pain. There are a number of factors that can increase your risk of developing back pain, or aggravate it once you have it. These include:

  • standing, sitting or bending down for long periods of time
  • lifting, carrying, pushing or pulling loads that are too heavy, or going about these tasks in the wrong way
  • poor posture
  • being obese (having a BMI of over 30)
  • an accident or injury

Sometimes, damage to parts of your spine can be the cause of back pain. This includes:

  • a slipped (herniated) disc – when a disc bulges so that it puts pressure on your spinal nerves
  • a fracture – a crack or break in one of the bones in your back
  • osteoporosis – a condition where bones lose density causing them to become weak and compress
  • spinal stenosis – a condition in which the channels that house your spinal column or nerves in your spine narrow
  • spondylolisthesis – when one of your back bones slips forward and out of position
  • degenerative disc disease – when the discs in your spinal cord gradually become worn down
  • osteoarthritis – a wear-and-tear disease that can particularly affect the joints of your spine
  • rheumatoid arthritis – an inflammatory condition in which your immune system causes inflammation of the lining of your joints and surrounding structures

Back pain may also be caused by an infection or cancer, but these causes are rare.

Diagnosis of back pain

Your GP will usually be able to diagnose lower back pain from your symptoms and by examining you, and there will often be no need for further tests. If your symptoms don't improve after a few weeks, or you have other symptoms, he or she may refer you to have tests, which might include:

  • an X-ray
  • an MRI scan (a test that uses magnets and radio waves to produce images of the inside of the body)
  • blood tests

These tests are used to find out if your back pain has a specific cause.

Treatment of back pain

If your back pain is non-specific, your GP may recommend you try self-help measures. He or she may also prescribe medicines or refer you for physical therapy if you need it.

If your GP suspects your pain has a specific cause, he or she may refer you to a back clinic or to see a specialist.

Self-help

There are a number of things you can do to help relieve back pain.

  • Stay active and continue your daily activities as normally as you can. Bed rest may actually make back pain worse, so try to limit the time you spend resting to a minimum.
  • Apply heat to the affected area. This has been shown to give short-term relief in symptoms. You can buy specially designed heat packs from most pharmacies.

Medicines

Taking an over-the-counter painkiller (paracetamol) or anti-inflammatory medicine (such as aspirin or ibuprofen) can relieve back pain and help you to stay active. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your pain is severe, your GP may prescribe stronger medicines such as a codeine-based painkiller or stronger anti-inflammatory medicine. He or she may prescribe a muscle relaxant such as diazepam if there is a lot of spasm. However, these aren't suitable for everyone because they can be addictive and cause side-effects. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Physical therapies

Your GP may refer you for physical therapy such as physiotherapy, chiropractic treatment or osteopathy to help with your back pain. Treatment can involve exercises, posture advice, massage and techniques known as spinal mobilisation and spinal manipulation. A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) can help you design a programme to help you exercise and stretch.

Treatment courses usually last up to 12 weeks.

Surgery

Back surgery is only considered if you still have severe back pain after you have tried all other treatments. Surgery may also be considered if there is a disk that is causing significant nerve compression.

Complementary therapies

Some people find that acupuncture can help relieve back pain. Your GP may refer you for a course of up to 10 sessions over a 12-week period.

Your GP may refer you to a pain-management programme, where different methods, including talking therapies, can help you manage and deal with your symptoms.

You should always talk to your GP before trying any complementary therapy.

Prevention of back pain

Good back care can greatly reduce your risk of getting back pain. To look after your back, make sure you:

  • take regular exercise – walking and swimming are particularly beneficial
  • bend from your knees and hips, not your back
  • maintain a good posture – if you work at a desk/computer, make sure your chair, desk and computer screen are set up correctly (you may be able to have an occupational work station assessment through your employer)

 

Produced by Rebecca Canvin, Bupa Heath Information Team, May 2013.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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