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Back Pain

Date issued: December 2022

Review date: December 2024

Ref: A-532/NB/ED/Back Pain

PDF:  Back Pain final December 2022.pdf [pdf] 106KB

What causes back pain?

  • 80% of low back pain is referred to as ‘non-specific’ and there is no known cause

  • Back pain is rarely due to any serious cause

  • 8 out of 10 people will have back pain at some stage

  • 95% of low back pain will resolve in 6 weeks from onset

  • Sometimes a disc in the back can press on a nerve and pain is felt in one of the legs. This is called sciatica.

Do I need an x-ray?

  • X-Rays will identify broken bones, not discs or nerves.  If you haven’t suffered any significant trauma, then an x-ray won’t help us identify the cause of your pain and will involve exposing you to radiation unnecessarily.

Do I need a scan?

  • An MRI scan is sometimes useful and may be requested by your GP.  Emergency MRI scans (i.e., one requested by the Emergency Department) are only required if we feel you have a condition called cauda equina syndrome which usually requires emergency surgery.

What can I do to help myself?

  • Stay active and avoid prolonged bed rest

  • Keep up daily activities and remain at work if possible

  • Gentle exercise and movement can help to relieve the pain

  • Be aware of good posture and change your position regularly.

Do I need to be on bed rest?

No. Latest medical research supports that prolonged bed rest is bad for backs as it can result in:

  • reduced flexibility             

  • muscle weakness

  • joint stiffness           

  • reduced general fitness

What is the treatment?

  • Painkillers and anti-inflammatory medication are both vital to help you recover.

  • Paracetamol is useful to ease pain. It is best to take it regularly for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day. A doctor may prescribe additional painkillers such as codeine if the pain is more severe.  If you are prescribed a combination of paracetamol and codeine (e.g., cocodamol or codydramol) then it is important not to take additional paracetamol as you will accidentally overdose.

  • Anti-inflammatory medication can be used with paracetamol or as an alternative. There are many types and brands. They relieve pain and reduce inflammation and swelling (often the cause of the pain). You can buy ibuprofen at pharmacies or supermarkets without a prescription. The dose varies depending on your age and other medical problems. Side-effects sometimes occur with anti-inflammatory painkillers. Ask your doctor or pharmacist for advice regarding them.

  • There are other medications which can be used, but generally only after simple painkillers (such as those above) have failed to control your symptoms.

  • Often your doctor will recommend physiotherapy.

Return to the Emergency Department if:

Less than 1% present with a serious cause for their back pain. They present with symptoms, known as ‘Red Flags’, which require urgent medical attention. If you have some of these signs or symptoms it is important that you alert your GP or another medical professional immediately:

  • Difficulty passing urine or having sensation to pass urine that is not there

  • Loss of bladder or bowel control

  • Numbness/tingling around genitals or buttocks area

  • Impaired sexual function, loss of erections or sensation

  • Loss of power in both legs

  • A fever or feeling unwell

  • History of trauma to back.

Contact your General Practitioner if:

  • The pain doesn’t settle, or you feel you require additional painkillers.

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