Back pain: causes, treatment, how long it lasts and when to worry

The NHS says back pain can have many causes, it is not always obvious what causes it, and it often gets better on its own. A common cause is an injury such as a pulled muscle (strain). Sometimes medical conditions such as a slipped disc, sciatica (a trapped nerve) or ankylosing spondylitis can cause back pain. Very rarely, back pain can be a sign of a serious problem such as a broken bone, cancer or an infection.

NICE guidance for clinicians stresses thinking about alternative diagnoses when examining or reviewing people with low back pain, particularly if new or changed symptoms develop, and excluding specific causes such as cancer, infection, trauma or inflammatory disease such as spondyloarthritis.

The NHS says back pain often improves on its own within a few weeks, and gives these steps to help speed up recovery. If back pain is severe or not getting better you may be prescribed painkillers, and other treatments may be recommended if the pain does not get better after a few weeks.

• Stay active and try to continue with your daily activities. Do not stay in bed for long periods.

• Take anti-inflammatory medicine like ibuprofen, which may not be suitable for everyone. Paracetamol on its own is not recommended for back pain but it may be used with another painkiller. Check with a pharmacist or GP.

• Use an ice pack (or bag of frozen peas) wrapped in a tea towel to reduce pain and swelling, or a heat pack wrapped in a tea towel to relieve joint stiffness or muscle spasms.

• Try exercises and stretches for back pain, and activities like walking, swimming, yoga and pilates. Stop if your pain gets worse and see a GP for advice.

The pain may be in the lower back, which is most common, or in the upper back. The NHS says to see a GP if you have back pain and any of the following.

• It does not improve after treating it at home for a few weeks.

• It is stopping you doing your day-to-day activities, or you are worried about the pain or struggling to cope.

• You have lost weight without trying to.

• There is a lump or swelling in your back, or your back has changed shape.

• It does not improve after resting or is worse at night.

• It is worse when sneezing, coughing or pooing.

• It is coming from the top of your back, between your shoulders, rather than your lower back.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have back pain and you feel hot, cold, shivery or generally unwell, or it is severe pain that starts suddenly or is getting worse quickly.

It says to call 999 or go to A&E if you have back pain and any of the following. Do not drive to A&E. Bring any medicines you take with you.

• Pain, tingling, weakness or numbness in both legs.

• A loss of feeling around your genitals or anus.

• Changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself.

• Changes in how your penis or vagina feels during sex, not being able to get or keep an erection, or not being able to orgasm.

• Chest pain.

• The pain started after a serious accident, such as a car accident.

The NHS says back pain usually improves within a few weeks but can sometimes last longer or keep coming back, and that it often improves on its own within a few weeks. It recommends seeing a GP if it does not improve after treating it at home for a few weeks.

The sources used here do not give precise figures for how long chronic back pain lasts. NICE says that for people at higher risk of a poor outcome, more complex and intensive support may be considered, for example exercise programmes with or without manual therapy.

The NHS says it is very common to get backache or back pain during pregnancy, especially in the early stages. During pregnancy the ligaments naturally become softer and stretch to prepare you for labour, which can put a strain on the joints of your lower back and pelvis.

NHS tips include bending your knees and keeping your back straight when you lift, avoiding heavy lifting, wearing flat shoes, balancing the weight between two bags, keeping your back straight and well supported when sitting, getting enough rest, using a mattress that supports you properly, and going to a back care class. You can take paracetamol to ease back pain in pregnancy unless your GP or midwife says not to.

Contact your GP or midwife urgently if you have back pain and you are in your second or third trimester, which could be a sign of early labour, you also have a fever, bleeding from the vagina or pain when you pee, or pain in one or both sides under your ribs. Call 999 or go to A&E if you lose feeling in one or both legs, your bottom or your genitals.

The NHS says that in many areas you may be able to get help, such as physiotherapy, from NHS community musculoskeletal (MSK) services without needing a referral from a GP. NICE says imaging should not routinely be offered in a non-specialist setting for low back pain, and that people referred for a specialist opinion may not need imaging.

Private physiotherapy, osteopathy, chiropractic and pain services are available to self-referring patients. NICE says manual therapy should be considered only as part of a package that includes exercise, and advises against acupuncture, ultrasound, TENS, traction, belts and corsets, so ask any private practitioner how a proposed treatment fits with national guidance.