Back pain
Almost everyone has a painful lower back at some point in life. Nearly always it means neither that the spine is falling apart nor that you should take to…
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Medicines commonly prescribed for Back pain
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 100 mgActive substance: ibuprofenManufacturer: Nutra Essential Otc S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Normon S.A.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 MG/5 MLActive substance: ibuprofenManufacturer: Laboratorios Ern S.A.Prescription required
Almost everyone has a painful lower back at some point in life. Nearly always it means neither that the spine is falling apart nor that you should take to your bed: the pain settles by itself within a few weeks, and what you do in the first days makes a visible difference to how quickly that happens. Something else matters far more — being able to tell ordinary back pain from the short list of warning signs that turn it into a matter of hours.
Where the pain usually comes from
In most people no exact cause can be pinned down, and that is the normal state of affairs rather than a gap in the workup. Pain of this kind is called non-specific: the muscles, the ligaments and the small joints of the spine have been overloaded and answer with spasm and protective tension. The trigger may be an awkward movement, a long drive, hours spent bending over, decorating the house, a new routine at the gym — and sometimes nothing you can point to at all.
Less often there is a specific finding behind it. A disc between two vertebrae can bulge and press on a nerve root; the pain then shoots into the buttock and runs down the leg, with numbness or pins and needles alongside it. That pattern is called radicular pain, and along the course of the sciatic nerve it is known as sciatica. In a young adult whose back is worst in the morning, stiff for more than half an hour and easier once they get moving, an inflammatory disease of the spine is worth considering. In someone with osteoporosis a vertebra can fracture with no fall at all.
Very rarely back pain turns out to be a sign of a tumour or an infection of the spine. It is for that rare fraction that the warning signs listed below exist.
The first few days
The main rule is short: keep moving. Bed rest does not speed recovery from back pain, it slows it down — muscles weaken, stiffness builds up, and getting back to ordinary life becomes harder. Ease the load, but do not put life on hold.
- keep up your usual routine and take short walks, even if you are moving more slowly than normal;
- among the options sold without a prescription, non-steroidal anti-inflammatory drugs usually work better for back pain; paracetamol on its own does little here, though it can be combined with another painkiller;
- heat from a hot water bottle or a warm shower relaxes spasm, while cold applied through a towel helps in the first day after an injury. Choose whichever feels better to you: there are no strict rules here;
- sleep in whatever position suits you; when the pain runs into the leg, many people find lying on their side with a pillow between the knees easier;
- do not wait for the pain to disappear completely before you start moving — movement is the treatment.
A separate word about scans. X-rays and MRI are not needed in the first weeks of ordinary back pain and can do harm: bulging discs and worn vertebrae show up in huge numbers of people who feel nothing at all, while the picture itself frightens patients and pushes them towards treatment they do not need. Imaging belongs where there are warning signs, or where surgery is being discussed.
Which movement actually helps
What works is not one particular exercise but doing something regularly. Walking, swimming, yoga, Pilates and work on the abdominal and back muscles all qualify. Start small and add a little at a time.
Use your own sensations as the guide: moderate discomfort during a session is acceptable, sharp pain is not. If the pain flares after exercise and lasts longer than a day, or begins to travel into the leg, cut the amount back and go through the programme with a physiotherapist.
When to see a doctor
Book an appointment if:
- the pain has not eased after several weeks of looking after it yourself;
- it is getting in the way of work, sleep or caring for yourself;
- it keeps growing worse over time instead of settling;
- it travels into the leg below the knee, or there is numbness or weakness in the foot;
- the pain worries you and you do not know what to do about it.
Some features are worth an earlier appointment even while the pain is still bearable: a first episode of severe pain after fifty, cancer in the past, unexplained weight loss, fever with night sweats, pain that wakes you at night and does not change with position, long-term treatment with glucocorticoids, known osteoporosis, and pain that started after a fall or a heavy blow.
Signs that call for emergency care
Call your local emergency number (112 in much of Europe) or go to the nearest emergency department straight away if back pain comes together with any one of the following:
- numbness or weakness in both legs at once;
- numbness in the perineum, around the back passage or on the inner thighs — the area that would rest on a saddle;
- being unable to pass urine or, the other way round, leaking it without control;
- loss of control over the bowels;
- sudden weakness in the foot, so that it gives way or slaps down as you walk;
- a high temperature together with severe back pain;
- pain that began after a serious injury, such as a fall from a height or a road accident;
- back pain combined with chest pain, breathlessness or fainting.
The first four points are possible signs of compression of the bundle of nerve roots at the bottom of the spine. The condition is rare, but it needs surgery within the next few hours: delay leaves lasting damage to bladder and bowel control and to sensation. Do not drive yourself in that situation — ask someone to take you or call an ambulance. Bring a list of the medicines you take.
When the pain drags on
Once pain has lasted longer than three months the approach changes. Hunting for one broken part and repairing it is usually futile; rebuilding tolerance to physical load step by step gives far better results. A doctor can choose a prescription painkiller, a short course of a muscle relaxant when the spasm is marked, or refer you to group physiotherapy, manual therapy or massage as an addition to movement.
Long-standing pain also responds to work with a psychologist in the form of cognitive behavioural therapy. That does not mean the pain is invented: pain that lasts rewires the way the nervous system works, and fear of moving amplifies the sensation on its own.
For chronic low back pain that responds to nothing else, a procedure is sometimes used that switches off signal transmission along the small nerves of the joint. Surgery comes up rarely, mostly for persistent radicular pain or narrowing of the spinal canal once everything else has been tried. Opioid painkillers bring little benefit in back pain and create problems quickly, so they are not prescribed in long courses.
What lowers the chance of it returning
There is no way to insure yourself completely, but the episodes can genuinely be made rarer and milder.
- regular activity all year round counts for more than any single "correct" exercise;
- strong trunk and hip muscles take load off the lower back;
- excess weight and smoking are linked to more frequent and more drawn-out back pain;
- in a desk job, change position and stand up every half hour, and keep the screen at eye level;
- lift heavy things close to the body, turning with the whole trunk instead of twisting the lower back;
- too little sleep and constant tension lower the pain threshold, and that is no small matter.
Online consultation
In an online appointment a doctor will ask what the pain feels like and where it travels, check whether any warning signs are present, explain whether imaging is needed right now, help you pick safe pain relief that fits with your other medicines, and map out a plan for returning to normal activity. If the description points to something that needs an examination in person or urgent care, the doctor will say so plainly and tell you where to go.
This material is for information only and does not replace medical advice.
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