Lower back pain is one of the most common health issues in New Zealand. In any year, about one third of New Zealanders will suffer from it.
Below are seven things you may be surprised to learn about the causes and treatments of acute low back pain.
1. Most lower back pain is not caused by a serious injury or disease
Some people worry that their lower back pain is a sign of a serious damage to the spine or a disease. This is generally not the case. Whilst some low back pain is caused by a mechanical or known condition (arthritis, nerve damage, osteoporotic fractures, or infection); most back pain has a ‘non-specific’ cause. This could be a sprain or strain, or the exact cause of the pain can’t be identified.
Lower back pain is usually not serious and doesn’t cause any lasting damage. For most people, low back pain will resolve or improve substantially within 2 to 6 weeks.
2. Keeping active is essential in managing back pain
It is important in the treatment of acute back pain that you continue your usual activities (including exercise and work) – or get back to them as soon as possible.
Maintaining your normal physical activity will help your back improve. It will not hurt your spine. It’s OK to feel a little bit of pain and discomfort. Start gently and try modifying the way you do things to make yourself more comfortable. Keep away from anything overly strenuous for the first couple of days – such as heavy contact sports.
3. If you do need them, it is best to take pain killers regularly
It is also important to manage your pain so you can continue your normal activities. It is best to take pain killers regularly for a short period of time, so pain doesn’t stop you moving.
- Paracetamol may not be the best pain killer for low back pain.
Paracetamol is available over the counter – and is one of the safest painkillers when taken correctly. Whilst paracetamol may work for you, recent scientific studies have shown paracetamol is not effective for people who are seeing a doctor for acute back pain.
Other medicines which might help your back pain are:
- Non-steroidal anti-inflammatories (NSAIDs). These may help back relieve your pain somewhat. They can, however, have serious side-effects. Some lower strength NSAIDs are available over the counter. You should start with the lowest dosage required to manage your pain
- Topical NSAIDs (creams or gels like Voltaren) rubbed into your back. These can be effective and have fewer side effects
- Opioids (eg codeine) are not generally recommended, however your doctor might prescribe them if your pain is severe or if you cannot take NSAIDs
As always you should consult with your doctor or pharmacist to make sure you are taking back pain medication that is right for you.
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5. Bed rest is NOT recommended
In general bed rest is not recommended for low back pain. Whilst you may feel the need to rest in bed for a while, this should only be for short periods eg an hour or two. Don’t stay in bed for longer than 2 days. More than 2 days bed rest could do you more harm than good.
6. There are other non-medicinal treatments that might help
Other treatments that may be effective in helping you manage your pain include:
- Osteopathy, physiotherapy, chiropractic
- Exercise eg yoga
- Acupuncture
- Massage therapy
- Heat packs/cold compresses
7. There are psycho-social factors involved in persistent lower back pain
How you think about your back pain can influence how you recover from it and whether you are at risk of developing a chronic condition. Try not to worry. Knowing that your back pain is not harmful and should naturally improve can help.
Other potential risks are:
- Low mood, depression, or anxiety
- Problems at work/poor job satisfaction
- Heavy work
- Unsociable hours/shift work
- An over-protective family
- A lack of support
When to see your doctor
You should see your doctor if your lower back pain:
- Persists past a few weeks
- Is severe and doesn’t improve with rest
- Is worse when lying down
- Spreads down one or both legs, especially if the pain extends below the knee
- Causes weakness, numbness or tingling in one or both legs
Or you have:
- Unexplained weight loss, or
- Not returned to your usual activities within a few weeks
You should also see your doctor immediately if you have lower back pain and you have:
- Had a fall, blow or other trauma
- New bowel or bladder problems, including numbness in the groin or buttocks
- Redness or swelling on your back
- A fever
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References:
- https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#non-invasive-treatments-for-low-back-pain-and-sciatica
- https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30489-6.pdf https://www.acpjournals.org/doi/10.7326/M16-2367
- https://www.nps.org.au/news/is-paracetamol-effective-for-low-back-pain
- https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906
- https://pubmed.ncbi.nlm.nih.gov/32878493/
- https://www.healthnavigator.org.nz/media/1006/nz-acute-low-back-pain-guide-acc.pdf
- https://www.healthnavigator.org.nz/health-a-z/b/back-pain/
