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The Beyond Pain Foundation

Conditions we support

Conditions guide

Chronic back pain

Back pain is very common, and most episodes settle within a few weeks. For some people it lasts for months or keeps coming back. This guide explains what chronic back pain is, the treatments available in the UK, what NICE says works and doesn't, and your rights at work.

People in the UK with low back pain each year
About 11 million
People who get back pain at some point
Up to 6 in 10
Counts as chronic after
3 months
UK rank as a cause of disability
Number 1

This guide is general information, not medical advice. Medicines and treatments must be prescribed or recommended for you by a doctor or pharmacist. We do not give doses here.

What chronic back pain is

Back pain is called chronic, or persistent, when it has lasted for more than 3 months. It most often affects the lower back. It can be there all the time, or come and go in flare-ups.

In most people, doctors can't point to one exact cause. This is called non-specific back pain. It does not mean the pain isn't real, or that something serious has been missed. Fewer than 1 in 100 people with back pain have a serious underlying problem.

Back pain can affect anyone, at any age. It is more likely if you are less active, carry extra weight, smoke, lift or twist a lot at work, or sit for long periods. Stress, low mood and poor sleep don't cause back pain, but they can make it hurt more and last longer.

Low back pain is the leading cause of years lived with disability in the UK. Musculoskeletal problems, including back pain, are one of the most common reasons people take time off work.

Types and causes

Doctors describe back pain in a few ways. You may hear more than one of these terms.

Non-specific back pain

The most common type. Pain comes from the muscles, joints and ligaments of the back, without a single clear cause. It can still be long-lasting and disabling.

Mechanical back pain

Pain that changes with movement and position, such as bending, sitting or standing for a long time. It often eases with rest or a change of position.

Facet joint pain

Pain from the small joints at the back of the spine. It is often worse leaning backwards or twisting. It is the type treated with radiofrequency denervation.

Disc-related pain

Pain linked to the discs between the bones of the spine, such as a slipped disc or disc wear.

Nerve pain (sciatica)

Pain that travels down the leg, often with tingling or numbness, because a nerve is pressed or irritated. See our sciatica guide.

Spinal stenosis

Narrowing of the space around the nerves in the lower back, usually in older people. It can cause aching, heavy legs when walking that eases when you sit or bend forward.

Inflammatory back pain

Caused by conditions such as axial spondyloarthritis (ankylosing spondylitis). Stiffness is worse in the morning and gets better with movement. It often starts before age 40.

Serious causes

Rarely, back pain is caused by a broken bone, an infection or cancer. These need urgent checks. See the warning signs below.

How it changes over time

Doctors often group back pain by how long it has lasted. Most people get better in the first few weeks.

  1. Up to 6 weeks

    Acute

    A new episode of pain. It usually improves within a few weeks with painkillers, heat or ice and staying active.

  2. 6 to 12 weeks

    Subacute

    Pain that hasn't settled. This is a good time to see a physiotherapist and check what may be holding recovery back.

  3. More than 3 months

    Chronic

    Long-term pain. The nervous system can become more sensitive, so pain is felt more easily. Treatment focuses on moving more and living well.

  4. Days to weeks

    Flare-ups

    Times when pain gets worse for a while, often after doing too much or during stress. Flare-ups usually settle. They don't mean new damage.

Timings are typical ranges, not exact rules. Back pain often comes back, so a new episode doesn't mean treatment has failed.

When to get urgent help

Some rare problems need treating quickly. Cauda equina syndrome happens when the nerves at the bottom of the spine are badly squeezed. It needs emergency surgery to prevent lasting damage. Don't drive yourself to A&E.

Call 999 or go to A&E if you have back pain and

  • numbness or tingling around your genitals or bottom, such as not feeling toilet paper when you wipe
  • difficulty peeing, or not being able to control when you pee or poo
  • numbness, tingling or weakness in both legs, or it is getting worse
  • chest pain
  • pain after a serious fall or accident

Call NHS 111 or your GP urgently if

  • your back pain is sudden and very severe
  • you also have a high temperature, or feel hot and shivery
  • you have had cancer, or have a weakened immune system, and get new back pain

See your GP if

  • the pain isn't improving after a few weeks
  • it stops you doing everyday things
  • it is worse at night, or very bad when you are resting
  • you have lost weight without trying
  • there is a lump or swelling on your back
  • the pain is in your upper back, between your shoulder blades

Diagnosis and referral

Your GP or physiotherapist will ask about your pain and examine your back and legs. They check for warning signs and ask how the pain affects your life, sleep, mood and work.

Most people don't need a scan. NICE advises against routine X-rays or MRI scans for low back pain in GP surgeries. Scans often show normal age changes that don't explain pain, and they rarely change treatment. A specialist may order an MRI if the result is likely to change your care, or if a serious cause is suspected.

Your GP or physio may use a short questionnaire, such as the STarT Back tool, to see if you are at higher risk of the pain lasting. People at higher risk should be offered more support earlier.

If your pain isn't improving, you may be referred to a community musculoskeletal (MSK) service, a hospital spinal team or a pain clinic.

You can often see a physio without your GP

In many areas you can refer yourself to NHS physiotherapy. Many GP surgeries in England also have a first contact physiotherapist you can book through reception. Search the NHS page get NHS help for back or joint problems to see what is available near you.

Treatments and medicines

NICE guidance (NG59) says the most helpful treatments for long-term back pain are active ones that help you move more and cope better. Medicines can help you keep active, but they rarely take pain away completely.

Exercise programmes

NHS physio, or a group class

NICE's first choice. This can be stretching, strengthening, aerobic exercise, Pilates or yoga, ideally in a group. Expect to give it at least 6 to 8 weeks before judging how well it works.

Manual therapy

Physiotherapist, osteopath or chiropractor

Massage, manipulation and mobilisation of the spine. NICE says it should only be used alongside exercise, not on its own. Osteopathy and chiropractic are usually paid for privately.

Anti-inflammatory painkillers (NSAIDs)

Ibuprofen from a pharmacy. Naproxen and others on prescription

NICE recommends these for back pain, at the lowest dose that works and for the shortest time. They aren't safe for everyone, so check with a pharmacist, especially if you have stomach, kidney, heart or asthma problems. Your doctor may add a medicine to protect your stomach.

Weak opioids

Codeine, on prescription. Low-strength co-codamol from a pharmacy

Only for short-term, new back pain when anti-inflammatories can't be taken or haven't worked. NICE says opioids should not be used for chronic back pain.

Psychological support

NHS Talking Therapies (self-referral in England), or via a pain service

Cognitive behavioural therapy (CBT) helps you manage pain, worry and sleep. NICE recommends it as part of a package with exercise.

Pain management programmes

Referral to an NHS pain service

Group courses that combine exercise, pacing, education and CBT, run by a team. NICE recommends them for people whose pain hasn't improved with other treatment, or where worry, mood or work problems are getting in the way of recovery.

What NICE does not recommend for low back pain

Medicines: paracetamol on its own, opioids for chronic pain, antidepressants (SSRIs, SNRIs and tricyclics such as amitriptyline) and anticonvulsants (such as gabapentin and pregabalin) for back pain alone.

Other treatments: acupuncture, TENS machines, ultrasound, interferential therapy, traction, back belts or corsets, foot orthotics and rocker-sole shoes.

If you already take any of these medicines, don't stop suddenly. Ask your GP or pharmacist to review them with you. Different advice may apply if you have nerve pain such as sciatica.

Specialist options and surgery

Most people with chronic back pain don't need surgery. If other treatments haven't helped, a specialist may discuss these options.

  1. Radiofrequency denervation

    Relief can take 1 to 2 weeks, and lasts days to months

    Heat is used to stop small nerves in the facet joints sending pain signals. NICE says it can be considered if your pain is moderate or severe, seems to come from these joints, and a test injection (a medial branch block) helped first. It is done as a day case.

  2. Pain clinic review

    Varies by area

    A pain specialist team can review your medicines, offer a pain management programme and help you plan for flare-ups. NICE does not recommend spinal injections for low back pain without sciatica.

  3. Surgery

    Only for specific causes

    Surgery may help when there is a clear cause, such as a slipped disc or spinal stenosis pressing on nerves. NICE says spinal fusion should not be offered for low back pain except in a research trial, and disc replacement should not be offered. If surgery is suggested, ask what the expected benefits and risks are for you.

Self-help and living well

During a flare-up

  • Keep moving gently. Bed rest slows recovery
  • Try a heat pack for stiffness, or a wrapped ice pack
  • Change position often and take short walks
  • Cut back activities for a few days, then build up again
  • Remember flare-ups pass and don't mean new damage

Day to day

  • Exercise regularly: walking, swimming, yoga or Pilates
  • Pace yourself: break tasks up and rest before pain builds
  • Keep a regular sleep routine
  • Look after your mood. Talk to someone if you feel low
  • Stop smoking and aim for a healthy weight if you can

The NHS has a free Pilates video for back pain, and the Chartered Society of Physiotherapy has exercises and advice.

Tips for getting the best treatment

Before your appointment

  • Keep a pain diary for 2 to 4 weeks: when it hurts, how bad (0 to 10), what helps, what makes it worse, and how it affects sleep and work
  • List all the medicines you take, including ones you buy, and whether they help
  • Write down the 2 or 3 things you most want to be able to do again
  • Mention any warning signs, such as numbness, weight loss or night pain

Questions to ask

  • Can I see a physiotherapist, or refer myself?
  • Is there a group exercise class or pain management programme near me?
  • Could talking therapy help me cope?
  • Are my medicines still the right ones? Should any be reduced?
  • Would a referral to a spinal or pain specialist help?
  • Can I have a fit note that suggests changes at work, rather than time off?

If you feel your treatment isn't working, you can ask for a review or a second opinion. In England you usually have the right to choose which hospital you are referred to, which can help if local waits are long.

Back pain and work

Staying in work, or returning early with the right changes, usually helps recovery. You don't need to be pain-free to go back.

Chronic back pain can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). This applies if it has a substantial (more than minor) effect on your daily life and has lasted, or is likely to last, at least 12 months. Pain that comes and goes can count. The law looks at how you would be without treatment.

If it does, your employer must make reasonable adjustments. These might include:

  • An ergonomic chair with good lower back support
  • A sit-stand desk or desk converter
  • A workstation assessment
  • A laptop stand, separate keyboard and mouse
  • Less lifting, or lifting aids and trolleys
  • Regular breaks to move and stretch
  • Flexible hours or working from home
  • A phased return after time off
  • Time off for physio and appointments
  • A parking space near the entrance

Access to Work is a government grant that can pay for specialist equipment and support at work. A fit note from your GP or physio can say you may be fit for work with changes. For advice on your rights, contact Acas or Citizens Advice.

Benefits

If you are off work, you may get Statutory Sick Pay from your employer for up to 28 weeks. If back pain makes everyday tasks or getting around hard, you may get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, whether or not you work. If you can't work, or can only work a little, check Employment and Support Allowance or Universal Credit. Turn2us and Citizens Advice can help you check.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

  • A course of private physiotherapy or osteopathy, alongside an exercise plan
  • A private pain management programme or group exercise course
  • A private consultation with a spinal or pain specialist
  • An ergonomic chair, sit-stand desk or other workstation equipment
  • Aids that make daily tasks easier, such as long-handled reachers or a perching stool

We fund treatment from registered practitioners. We can't pay for things you have already bought, debts or everyday living costs. Prices vary, so always get a written quote to include with your application. Ask your employer about Access to Work too, as it may cover some equipment.

Apply for funding Check the requirements

Support and sources

Arthritis UK

Charity (formerly Versus Arthritis)

Free helpline 0800 5200 520, Monday to Friday, 9am to 6pm. Information on back pain, exercise and work.

arthritis-uk.org

Pain Concern

Charity for people living with pain

Helpline 0300 123 0789. Leave a message and they will usually call back the next working day. Also leaflets and an online forum.

painconcern.org.uk

BackCare

National back pain charity

Information about back and neck pain, treatments and prevention. Phone 020 8977 5474.

backcare.org.uk
Sources for this guide

Last reviewed: October 2026.