The problem
Most people will get at least one bout of lower back pain in their lives. The good news? It can get better in a week and almost always within six weeks. But while you have it the pain can be excruciating, so that you feel as if you'll never be able to sleep, walk or enjoy life again. No wonder people try anything that might help. But last week a paper in the New Zealand Medical Journal found that the side effects of chiropractic treatments (spinal manipulations often used to treat back pain) have tended to be under-reported in trials.
Non-steroidal anti-inflammatory drugs – the painkiller of choice for back pain – also have risks, according to a paper in the BMJ. They increase the risk of stomach ulcers (which can cause internal bleeding) and some also raise the risk of heart disease. So what's the best thing to do if you get stricken by back pain?
The solution
Back pain is a symptom, not a disease. Usually no cause is found for it but you should still check it's nothing more serious. (You can feel pain in your back from things going wrong in almost any organ in your abdomen.) So if you have any red flags (as doctors call them) such as you are under 20 or over 55, have lost control of your bladder or bowels, have had cancer in the past, been on steroids for a long time, have weakness or numbness in a leg or arm, foot drop, or numbness around your bottom or genitals, or if you have night pain or progressively worse pain, then see your doctor as a priority.
Most people will have muscle ache or shooting pains and limited movement in their back. Even if you have pain that goes down your leg (from a nerve that has pressure on it from a slipped, bulging disc in the back), you are still likely to be one of the 90% that gets better within a month.
Whether you have slipped your disc or not, the treatment is the same. You don't need an x-ray unless you have a red-flag symptom. It may sound unsympathetic, but you should start moving normally as soon as possible, because research shows this will get you better faster.
Sleep on your side with a pillow between your legs to relieve pressure on your back. Initially you may need paracetamol or something stronger. Naproxen is the safest non-steroidal anti-inflammatory drug but if you have a history of stomach inflammation you may need another drug to protect the lining of your stomach. Some GPs give three days of valium to ease muscle spasm, which can also help you to sleep if the pain is bad. A Cochrane review of chiropractic interventions for low back pain found no advantage over other treatments and only a slight improvement.
There are no set exercises to do while you have the pain but once you have recovered you can try building up a six-pack to strengthen your trunk, which may reduce the risk of a recurrence. Avoid anything that triggered the back pain in the first place, for a while at least. If the pain gets worse rather than improving, go and see your doctor.
