Management of mechanical back pain (non-specific)
Royal College of General Practitioners (RCGP) Key Patient Information Points
Simple backache (Mechanical Back Pain):
Give positive messages.
- There is nothing to worry about. Backache is very common.
- No sign of any serious damage or disease. Full recovery in days or weeks – but may vary.
- No permanent weakness. Recurrence possible – but does not mean re-injury.
- Activity is helpful too much rest is not. Hurting does not mean harm.
Analgesics should be prescribed at regular intervals, not “as required”, starting with Paracetamol. This has been shown to effectively control most MBP. If this is ineffective, then Non Steroid Anti Inflammatory Drugs (NSAIDs) are often prescribed. These reduce pain and inflammation. Ibruprofen, Naproxen and Diclofenac are common examples. If the onset is severe, analgesics, which may be taken with NSAIDs may be prescribed. Muscle relaxants may also be given to relieve “spasms”.
Do not recommend or use bed rest as a treatment for simple back pain.
Some patients may be confined to bed for a few days due to pain, but this should not be considered a treatment. Bed rest for longer than 2 days is worse than placebo and not as effective as return to daily activities and work.
Advise patients to stay as active as possible and continue normal daily activities.
Activities should be increased gradually and progressively over a few days or weeks. If a patient is working, advise them to stay at work or return to work as soon as possible.
Early physical activity has been shown to aid rapid recovery from mechanical back pain. For mild to moderate back pain, a near normal schedule of activity is recommended from the outset. This is in keeping with the nature of MBP, which is a common everyday back problem of no long - term significance.
Assistive equipment (previously known as aids, appliances and adaptations) may be required in the more advanced stages of specific back pain, such as a moderate or severe condition.
For a moderate condition, a person may need to rely on minor prescribed assistive equipment, often hand held, such as kitchen or dressing aids, long handled shoe horn, and the use of a stick or bath/toilet equipment, e.g. raised toilet seat, (minor aids) for at least a part of the day.
For a severe condition, additional major prescribed assistive equipment (major aids) may be needed. This may include the use of a wheelchair or electric mobility vehicle, stair lift, hoist, foot drop orthosis, architectural adaptations and adapted access to property. Reliance on such prescribed assistive equipment may be necessary for much of the day. The use of such major aids would normally be in addition to the use of minor aids.
Although people are at liberty to acquire assistive equipment on their own initiative, only prescribed assistive equipment relates to the severity of the condition. Such prescription follows a thorough assessment of the person’s functional limitations by a qualified professional. Normally this is performed by an Occupational Therapist, working as part of a multidisciplinary team.