Low back pain
Also called: lower back pain, backache, lumbago, non-specific low back pain, kamar ka dard (back pain)
Low back pain is pain between the bottom of the ribs and the buttocks. It is the leading cause of disability in the world. Most episodes get better within weeks with staying active, exercise and simple care. Numbness around the bottom or new bladder problems need emergency help.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Low back pain means pain, ache or stiffness in the area between the lower edge of the ribs and the buttocks. Almost everyone has it at some time in their life. The World Health Organization (WHO) says about 619 million people had low back pain in 2020, and it is the single biggest cause of disability worldwide. It is most common around the age of 50 to 55, and women are affected more often than men.
In about 9 out of 10 people, no single disease or damaged structure can be found. Doctors call this non-specific low back pain. Less often, the pain has a specific cause, such as a slipped (herniated) disc pressing on a nerve, a broken bone in the spine, an infection, or a cancer. Pain is called acute when it lasts less than 6 weeks and chronic (long-lasting) when it lasts more than 12 weeks.
The good news is that most acute back pain settles on its own within a few weeks. Staying active, keeping up normal daily life and going back to work are among the most helpful things you can do. Guidelines put exercise, advice and support before medicines. Painkillers can help for a short time but should not be the main treatment. A small number of people have warning signs that need urgent care, especially signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
In Pakistan
Low back pain is common in Pakistan: a 2018 study of 669 government office workers in Lahore found that about 3 in 10 had it, and many reported poor sleep or a change in the way they walk.
Symptoms
- A dull ache or a sharp pain in the lower back, from mild to so bad that it is hard to move
- Stiffness and difficulty standing up straight, bending or turning
- Pain that spreads to the buttock, hip or down the leg (sciatica or radicular pain, meaning pain from an irritated nerve); it can feel like an electric shock
- Tingling, burning, numbness or weakness in the leg or foot when a nerve is involved
- Pain that limits movement and makes work, school and daily life harder
- Poor sleep because of the pain
- Low mood, worry or distress, especially when pain lasts a long time
Causes and risk factors
Causes
- Strain or minor injury to the muscles and ligaments of the back, often from lifting, a sudden movement, sitting in one position for a long time, or an accident
- Non-specific back pain, where no single cause can be found; this is the most common type
- A slipped (herniated) disc pressing on a nerve, causing sciatica
- Narrowing of the spinal canal (spinal stenosis), or curving of the spine
- A small break in a spine bone (compression fracture), often linked to thin bones (osteoporosis)
- Less often: infection, cancer, inflammatory arthritis of the spine, or pain coming from other organs such as the kidneys, pregnancy or a swollen main artery (aortic aneurysm)
What makes it more likely
- Low physical activity
- Smoking
- Being overweight (obesity)
- Heavy physical work, repeated lifting or twisting, and high physical stress at work
- Long hours of sitting or standing in one position
- Age, with the most cases around 50 to 55 years, and being female
- Pregnancy
- Stress, worry and low mood, which make it more likely that pain lasts longer
Complications
Most episodes of low back pain get better, but in some people it becomes chronic (lasting more than 12 weeks). Long-lasting pain can limit movement, work, schooling and family life, and can lead to poor sleep, low mood and distress. Medicines also carry risks: anti-inflammatory painkillers (NSAIDs) can harm the stomach, kidneys, liver and heart, and opioid painkillers can cause dependence and overdose. Rarely, a disc presses hard on the nerves at the base of the spine (cauda equina syndrome). If this is not treated quickly, it can cause permanent damage, such as loss of bladder or bowel control or paralysis of the legs.
When to see a doctor
- EMERGENCY - possible cauda equina syndrome: numbness or tingling between the inner thighs, in the genitals, or around the back passage or buttocks; changed feeling when wiping after the toilet; new difficulty starting, stopping or controlling urine; leaking urine or stool; or not knowing when your bladder is full. Go to the hospital emergency department straight away
- Pain, numbness or pins and needles in both legs, or leg weakness or difficulty walking that is getting worse
- Back pain with fever, or redness and swelling over the spine, which may mean an infection
- Back pain after a bad fall, accident or blow to the back
- Back pain in someone with a past history of cancer, or with weight loss that has no clear reason
- Pain that is worse when lying down, wakes you at night, or is different from or worse than earlier episodes
- Back pain in someone who uses steroid medicines long term or injects drugs
Diagnosis
Low back pain is usually diagnosed by talking to you and examining you. The doctor or physiotherapist asks where the pain is, how it started, how bad it is and whether it spreads to the leg. They check movement, feeling, strength and reflexes in the legs, and look for warning signs of a more serious cause such as cancer, infection, a fracture or inflammatory disease. NICE suggests a short questionnaire such as the STarT Back tool to judge whether you are likely to recover quickly or need more support.
X-rays, CT or MRI scans are not needed for most people, and NICE advises against routine imaging in general practice. Scans are usually not done in the first 4 to 6 weeks unless there are warning signs. In specialist clinics, a scan is done only if the result would change the treatment, for example before possible surgery for sciatica. Blood tests or scans are used earlier when warning signs are present.
Treatment
- Get reassurance and clear advice: most back pain improves within weeks. Keep moving and carry on with normal daily activities and work as much as you can. Avoid bed rest.
- Use self-care such as a cold pack in the first 2 to 3 days and warmth after that, and gentle walking, then build up activity step by step.
- If pain is not settling, or you are at higher risk of a slow recovery, a physiotherapist can give an exercise programme (often in a group). Manual therapy (spinal manipulation, mobilisation or massage) may be added, but only alongside exercise.
- For a short time, your doctor may suggest an anti-inflammatory painkiller (NSAID). Your doctor decides the dose and checks your stomach, kidney and heart risk; the lowest effective dose for the shortest time is used, sometimes with stomach protection.
- If an NSAID is not suitable or does not work for acute pain, a weak opioid such as codeine, with or without paracetamol, may be used for a short time. Opioids are not advised for long-lasting back pain. Paracetamol on its own, antidepressants, gabapentin or pregabalin are not recommended for low back pain.
- For long-lasting pain with stress, worry or low mood, a combined programme of exercise and psychological therapy such as cognitive behavioural therapy (CBT, a talking therapy) can help.
- If pain stays severe despite these steps, a specialist may consider options such as radiofrequency denervation (treating small nerves to the spine joints), an epidural injection for severe acute sciatica, or surgery for sciatica that does not improve.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Non-steroidal anti-inflammatory drugs (NSAIDs) | the medicine guidelines suggest considering first, for a short time, after checking stomach, kidney, liver and heart risks; older people and those with other illnesses should ask a doctor first | Ibuprofen (378 brands), Naproxen (5 brands), Diclofenac (26 brands) |
| Weak opioid painkillers (with or without paracetamol) | only for short-term acute back pain when an NSAID is not suitable, not tolerated or not working; not for long-lasting back pain because of the risk of dependence | Paracetamol + Codeine (8 brands) |
Also used (not yet in our price list): Epidural local anaesthetic with steroid injection (given by a specialist for severe acute sciatica)
Self-care and prevention
Self-care
- Stay as active as you can and keep up normal daily activities; avoid long bed rest
- Use a cold pack for the first 2 to 3 days, then switch to warmth (heat)
- Start gentle activity such as walking, swimming or cycling after the first couple of weeks, and build up slowly
- Avoid heavy lifting and twisting while the pain settles
- Sleep on your side with a pillow between your knees, or on your back with a pillow under your knees
- Try to return to work early, with lighter duties at first if needed
- Back belts and corsets are not recommended; guidelines say they do not help
Prevention
- Exercise regularly to keep your back and stomach (core) muscles strong and flexible
- Keep a healthy weight
- Lift safely: bend your knees, keep the load close to your body, avoid twisting and get help with heavy loads
- Take breaks from long sitting or driving, and use a chair that supports your lower back
- Do not smoke
- Look after your mental well-being and get good sleep
Common questions
Should I rest in bed when my back hurts?
No. Bed rest is not advised. You may need to do a little less for the first few days, but guidelines advise staying active and carrying on with normal activities and work as much as possible.
Do I need an X-ray or MRI for back pain?
Most people do not. Scans rarely change the treatment for ordinary back pain and are usually not done in the first 4 to 6 weeks. Your doctor will arrange a scan if there are warning signs or if surgery is being considered.
Which painkiller is best for low back pain?
Guidelines suggest an anti-inflammatory painkiller (NSAID) for a short time if needed, after your doctor checks it is safe for you. Paracetamol on its own is not recommended, and opioids are not advised for long-lasting back pain. Medicines work best alongside exercise and staying active.
How long does low back pain last?
Most acute back pain improves within a few days to a few weeks, and many people are better within 4 to 6 weeks. Pain lasting more than 12 weeks is called chronic and needs a planned approach with exercise and support.
When is back pain an emergency?
Go to the emergency department straight away if back pain comes with numbness around the genitals, bottom or inner thighs, new problems passing or controlling urine or stool, or weakness in both legs. These can be signs of cauda equina syndrome, which needs urgent treatment to prevent permanent damage.
Sources
- NICE. Low back pain and sciatica in over 16s: assessment and management (NICE guideline NG59) (2020).
- World Health Organization. WHO releases guidelines on chronic low back pain (2023).
- World Health Organization (fact sheet). Low back pain (2023).
- MedlinePlus (US National Library of Medicine). Low back pain - acute: MedlinePlus Medical Encyclopedia (2026).
- NHS - The Dudley Group NHS Foundation Trust. Back Pain and Cauda Equina Warning Signs (2022).
- Pakistan Armed Forces Medical Journal (via DOAJ). Prevalence of Musculoskeletal Low Back Pain in Office Workers at Lahore, Pakistan (2018).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.