Pain in the back is common, and in most cases gets better on its own within a few weeks. Low back pain is the most common, but of course, back pain can affect any part of the back – lower, middle or upper. In most people, a specific cause cannot be found and it's most often due to a strain or sprain. This can arise from a specific event of lifting heavy objects with incorrect positioning, or over time from overuse or incorrect posture. Sciatica and a slipped disc are common conditions causing low back pain, where pain is caused by nearby nerves getting temporarily trapped. It is also possible to suffer a break in one of the bones of your back, called your vertebra. This may occur after an injury or related to a medical condition. Back pain can also very rarely be a sign of cancer and so it is always important to pay attention to any significant concerning signs of back pain. In this article, we will discuss our approach to treating back pain: when you should start treatment yourself, top tips to help soothe the pain alongside painkillers, and when to seek advice from your doctor.
Before reaching for the tablets and creams, we’d recommend starting with some good old-fashioned stretching it out. For the majority of mild back pains, this may be all that is needed. With back pain where there was not a severe or immediate injury, it is important to keep moving and stretching as regularly as possible to reduce pain and stiffness. Exercises like swimming, yoga, pilates and walking are particularly good for strengthening the muscles in your back and improving your posture. Keep a good posture in mind when lifting or moving objects to avoid straining your back. Think about distributing your weight: keep legs apart and bend at the knees, not the back. Avoid twisting while lifting. If you spend hours at a laptop or PC, keep in mind your posture and take regular breaks to stretch out and straighten up. Regular massages can help ease up tight muscles, or hot baths with magnesium or Epsom salts. If the pain is more immediate and in the few days after injury, it is sensible to try applying a cold compress on the area, such as a bag of frozen peas in a towel, for up to 20 minutes. After a few days, a hot compress such as a hot water bottle can be applied to improve soreness and ease aching muscles. A TENS (transcutaneous electrical nerve stimulation) machine can be applied directly to the back, and many find this helps with long-term back ache.
Paracetamol is usually a safe and sensible place to start when reaching for pain relief, with relatively few risks or side effects if taken as instructed. It’s well-tolerated and may be sufficient for occasional mild pain that occurs for just a brief time. Another good first-line option is non-steroidal anti-inflammatory drugs (NSAIDs) which are a class of medications that work on pain and dampen down inflammation. Ibuprofen has a similar effect on pain as paracetamol, but can be particularly effective in cases of back pain, where mild inflammation causes much of the pain. Paracetamol and ibuprofen are available to buy from any pharmacy, but stronger tablet NSAIDs such as naproxen, diclofenac or indometacin need a prescription. There are also topical NSAIDs – creams or gels – that can be purchased over-the-counter, such as Voltarol (containing diclofenac).
If your back pain is needing something stronger than paracetamol and ibuprofen, the next step is the family of medications known as opioids. Opioids include a wide-ranging scope of pain relief, from codeine at the mildest end, to tramadol as a medium strength, and different forms of morphine at the strongest end. Side effects become more pronounced with stronger doses – commonly constipation, drowsiness and feeling dizzy, sick or slightly out of it. Certain people seem more susceptible to this “wooziness” than others. You can buy a low dose of codeine phosphate or dihydrocodeine (they are very similar drugs) in the pharmacy, and it’s often combined with paracetamol (co-codamol). Higher doses are only available on prescription. If you are needing stronger painkillers than co-codamol, you should probably be seeing your doctor about your back pain. Your doctor will consider whether there is another underlying cause.
If your pain is not improving after a few weeks despite care and exercise at home, if the pain is severe or getting worse, or if it is affecting your daily activities, you should see your doctor to discuss this. Concerning signs that suggest you should book an urgent appointment with your doctor are lack of control when peeing or pooing, numbness around the buttocks and back passage, numbness in your legs, weakness of your lower legs, fevers or night sweats without obvious cause, weight loss, or back pain that wakes you up at night. If you get back pain and you are under 18 or over 50 years old, you should request an urgent appointment with your doctor to discuss the cause.