What is back pain?

Back pain includes pain that affects any area of your spine or the surrounding muscles, nerves and tissues.

Your back includes the area from your neck to your buttocks.

The adult spine is made of 24 individual vertebrae stacked on top of each other. These are the bones that make up your spine and the bony tunnel (spinal canal) that encases and protects your spinal cord.

Between your vertebrae are ‘intervertebral discs’. These spongy cushions act as shock absorbers. Ligaments, tendons and muscles also hold your spine together and allow it to flex and bend.

The spine is divided into 5 regions:

• cervical — includes your neck region, from where your skull is attached to your spine, down to your shoulders
• thoracic — the region where your ribs attach to your spine
• lumbar — lower back
• sacrum — the 5 vertebrae that fuse to form a triangular bone that is attached to your pelvic bones
• coccyx (tailbone) — the 4 joined (fused) vertebrae at the base of your spine, where your pelvic floor ligaments and muscles attach

Back pain can affect any area of the back, but it most commonly affects the lower back.

Back pain can be acute or chronic:

• Acute pain lasts for a short time only and may have a clear cause (for example, accident or injury).
• Chronic pain lasts longer than 3 months, and often needs to be managed differently.

Learn more about chronic pain and options for managing it.

What causes back pain?

Specific causes of back pain

Problems with any of the bones, muscles, nerves or connective tissues of the back can lead to back pain, including:

• osteoarthritis
• inflammatory arthritis, such as spondyloarthropathies and ankylosing spondylitis
• bone fractures, which are more common if you have osteoporosis
• herniated disc

Very rarely, back pain results from a serious condition, such as a spinal infection or cancer.

Non-specific back pain

In most cases, your doctor won’t identify a specific cause of the pain. This pain is known as ‘non-specific back pain’.

While this can be frustrating, it should also reassure you that your pain isn’t caused by a serious medical problem.

Factors that can worsen non-specific back pain include:

• soft tissue injuries
• stress
• smoking
• lack of exercise
• overweight or obesity
• sudden increase in load on the spine — for example, lifting heavy objects or children, when you’re not used to it
• mental health conditions such as anxiety or depression

When should I see my doctor?

You should see your doctor if your back pain isn’t getting better after about 6 weeks or is affecting your ability to sleep or perform daily activities. They can give you advice about measures you can take to relieve and manage your back pain.

You should call triple zero (000) or go to your nearest emergency department if:

• the pain has come on very quickly and is severe
• the pain is the result of a significant injury or accident
• you have a fever or are unwell, along with the pain
• you can’t walk or move due to the pain
• you have symptoms such as muscle weakness or numbness in your legs, or changes to your bladder or bowel function (such as incontinence or urinary retention)
• you have been experiencing unexplained weight loss

How is back pain diagnosed?

Your doctor will ask questions about your symptoms, medical history and general health, and will give you a physical examination.

In most cases, you won’t need special tests such as x-rays, CT scans or MRI scans to diagnose the cause of your pain. Your doctor can discuss with you whether they think these are necessary.

If you do have a scan, it’s important to remember that it’s normal to experience changes to your spine over time that can be seen on an imaging scan. These don’t necessarily mean that your spine is damaged.

How is back pain treated?

Most episodes of acute back pain eventually pass on their own without special treatment.

Your doctor may prescribe medicines to help relieve short-term back pain, such as oral anti-inflammatory medicines (NSAIDs) or topical anti-inflammatory medicines applied to the skin via a cream, gel, ointment, spray or patch.

Paracetamol has not been shown to be effective for acute or chronic back pain.

While opioid medicines may offer short-term relief of acute, severe back pain, they aren’t usually recommended due to the high risk of significant side effects and potential harm.

Living with back pain

There are many things you can do to minimise and manage back pain, especially if it persists or recurs:

• Keep physically active: Resting your back can often make the pain worse; keeping active can relieve symptoms such as pain and poor sleep.
• Maintain a healthy weight: This can help reduce the load on your spine.
• Quit smoking: Smoking has been shown to increase the risk of developing back and neck pain and some kinds of arthritis.
• Manage your stress levels: Stress makes pain worse by causing increased muscle tension and spasm. You can try also strategies such as mindfulness meditation, which has been shown to reduce pain levels.

Here are some tips for managing back pain while you go about your daily activities:

• Consider your environment: Ensure that your back is well supported while sitting and standing in different environments. Consider your furniture at home and in your workspace and in the car. An occupational therapist can give you advice about special support and aids that may help.
• In the car: On long car journeys, make sure you adjust your seat, mirrors and steering wheel before you start. Plan regular breaks to get up and stretch your back.
• Safe manual handling: If you have a physical job, you are at risk of back injury. Your employer must keep your workplace safe. They must teach you how to handle heavy loads safely, and you should follow your workplace guidelines.
• Workplace design and posture: Your work may require you to sit or stand for many hours. Poor posture can cause back injury or pain. Your workstation should be designed to allow you to stand and sit in a way that supports your back.

Complications of back pain

While most cases of back pain itself don’t have a serious cause, back pain can have a significant impact on your health and wellbeing. People with chronic back pain are at a higher risk of suffering from psychological distress and may experience difficulties with their work or daily activities.

Learning to manage back pain can help reduce its impact on your health and wellbeing.

Resources and support

• Visit WorkSafe Victoria to watch videos explaining manual handling in the workplace and how to prevent injury.
• Find a physiotherapist — use the Australian Physiotherapy Association search tool to find physiotherapists to prevent or treat upper back pain.
• See the Musculoskeletal Australia website for information about back pain and tips to manage and prevent back pain.
• Learn about why it is important to be physically active at the Australian Physiotherapy Association website.
• Call the National Arthritis and Back Pain Help Line on 1800 263 265.
• For help to quit smoking, call Quitline or Aboriginal Quitline (staffed by Aboriginal counsellors) on 13 7848 (13 QUIT).
• You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Other languages

The following translated resources are available:

• Understanding pain and what to do about it? (video), from the Agency for Clinical Innovation (Pain Management Network)
• Acute low back pain patient fact sheets from NSW Multicultural Health Communication Service