In short: Most lower back pain is "non-specific", meaning it comes from the muscles, ligaments and joints of the back rather than a serious underlying cause, and it usually improves within a few weeks. Staying active, keeping up normal activities as much as possible and a structured exercise programme are the mainstays of treatment under NICE guideline NG59. Scans are rarely needed, and urgent help is required only if certain red-flag symptoms appear.

This guide, written by a Ready Health prescribing pharmacist, explains the common causes of lower back pain, what NICE recommends, and when to seek help in Wigan or urgently.

What causes lower back pain?

For most people there is no single identifiable cause. Common contributors include:

muscle or ligament strain, for example after lifting, twisting or a sudden movement
age-related changes in the discs and joints of the spine
a disc bulge pressing on a nerve, which can cause sciatica (pain spreading down the leg)
long periods of sitting, low activity levels or being deconditioned
stress, low mood and poor sleep, which can make pain feel worse and last longer

Less commonly, back pain is caused by conditions such as a fracture, infection, inflammatory arthritis (for example axial spondyloarthritis) or cancer. These are why red flags matter.

When is lower back pain an emergency?

Go to A&E or call 999 immediately if back pain comes with any of these possible signs of cauda equina syndrome:

numbness or tingling around your bottom, genitals or inner thighs (saddle area)
new difficulty passing urine, loss of bladder or bowel control
sciatica in both legs, or weakness in the legs that is getting worse
new sexual dysfunction

See a GP urgently if you also have a fever, unexplained weight loss, a history of cancer, back pain after a significant fall or injury, constant pain that is worse at night, or if you are under 20 or over 50 with new back pain.

What does NICE NG59 recommend for lower back pain?

NICE guideline NG59 covers low back pain and sciatica in people aged 16 and over. Its key recommendations include:

Self-management: reassurance, information and encouragement to stay active and continue normal activities, including work where possible.
Exercise: a group or individual exercise programme (such as stretching, strengthening, aerobic exercise, yoga or pilates) is the main treatment for ongoing pain.
Manual therapy: spinal manipulation, mobilisation or massage only as part of a package that includes exercise.
Psychological support: approaches such as cognitive behavioural therapy alongside exercise, particularly when pain is persistent or affecting your life.
Risk assessment: using a tool such as STarT Back to identify people who need more support.
Imaging: X-rays or MRI should not routinely be offered in non-specialist settings. A scan is considered only if a serious cause is suspected or if the result would change the treatment plan.

Medicines

NICE suggests considering an anti-inflammatory painkiller (NSAID) at the lowest effective dose for the shortest time, taking into account stomach, kidney and heart risks. Paracetamol on its own is not recommended for low back pain because evidence shows little benefit. Weak opioids may be considered for short-term acute pain only if an NSAID is unsuitable or has not worked. NICE does not recommend antidepressants or anticonvulsants (such as gabapentin) for low back pain. Sciatica has some separate recommendations. A pharmacist or prescriber can help you choose safely.

Treatments NICE does not recommend

NICE advises against belts, corsets, foot orthotics, traction, acupuncture, TENS and therapeutic ultrasound for low back pain, and does not recommend spinal injections for non-specific low back pain.

Can physiotherapy help lower back pain?

Yes. A physiotherapist can assess how you move, tailor an exercise programme and use manual therapy alongside exercise, which is in line with NICE advice. At Ready Health, physiotherapy is provided through our partner physiotherapists, and our clinicians can assess you first and arrange imaging if it is clinically needed.

Frequently asked questions

How long does lower back pain last?

Most episodes improve significantly within a few weeks. If pain lasts longer than around six weeks, is getting worse or is stopping you working or sleeping, seek a review.

Should I rest with back pain?

Bed rest is not recommended. Gentle movement and returning to normal activities as soon as you can usually helps recovery.

Do I need an MRI scan?

Usually not. Scan findings such as disc wear are common in people without pain and often do not explain symptoms. A clinician will recommend imaging only if it is likely to change your management.

Is heat or ice better?

Either can help in the short term. Use whichever feels better, protecting your skin.

Key takeaways

Most lower back pain is non-specific and improves within weeks.
Stay active; exercise is the core treatment recommended by NICE NG59.
Routine scans and paracetamol alone are not recommended.
Saddle numbness, bladder or bowel changes or leg weakness need emergency care.

Sources and further reading

Last reviewed: October 2026 by Shamir Patel, Independent Prescribing Pharmacist, Ready Health. This article is general information and does not replace advice from your own clinician.

Back pain not settling? Ready Health in Standish, Wigan offers clinical assessment and physiotherapy through our partner physiotherapists. Find out about physiotherapy or book a GP appointment.