Most treatment is wasteful, wanton and wrong, says the Lancet. The key is to try to keep walking and working.
The good news is that if your backache is musculoskeletal — and it usually is — 90% of cases will be better within six weeks. And that is irrespective of what you do. There’s no good evidence that interventions, ranging from Tens machines (which use a mild electric current), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly effect the outcome. Prolonged bed rest — still advocated in some countries — is positively dangerous, as it can cause blood clotting (thrombosis) and makes recovery from back pain less likely.
It’s tempting to want a scan or special investigations if you develop back pain. But scans don’t correlate well with symptoms; you can have a dire-looking scan with no symptoms or a fairly normal-looking one with dreadful pain. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back pain is associated with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.
The key to recovery is to try to keep walking and working. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s cheap, safe, and happens to work for me.
Painkillers can be useful in the short term, if that’s the only way you can keep moving.