Severe back pain can be frightening and difficult to cope with.

Some serious problems can cause severe back pain but most often it is just a simple lower back strain that is the culprit.

But does having severe back pain mean you have a serious back problem?

When you have very severe back pain it is very easy to panic and fear the worst. There are two very important things to remember

  • Pain is not always a reliable signal of tissue damage or harm.


The amount of pain does not always indicate that there is a serious underlying problem. It is quite possible to have really extreme lower back pain from a muscle spasm and very little pain from cancer for example. So first things first the pain on its own is not telling you that you have done something really dreadful to your back.

  • The chances of you having a worrying spinal problem are low – less than 1% of back pain sufferers have a serious problem.

Despite the low odds it is really important that if you are one of those 1% that you get checked out. So let's talk about the serious problems and the signs and symptoms to look out for.

Signs and Symptoms of serious or worrying back problems

MRI scanThese signs are called red flags and they raise the index of suspicion that there may be a more serious underlying problem and mean you may need more tests to rule them out. If you have any of these signs or symptoms you need to see a doctor straight away.

The main categories of worrying problem are:

  • Spinal Cord Compression (Cauda Equina)
  • Cancer
  • Infections
  • Fractures

Signs of cauda equina syndrome or compression of the bottom part of the spinal cord

  • Urinary (bladder) retention or incontinence
  • Loss of bowel or bladder sensation or control
  • Saddle anaesthesia (altered sensation in the saddle area)
  • Changes in gait or leg control

Possible signs of cancer

  • History of cancer
  • Generally unwell - this can be a sign of infection, inflammation, or cancer.
  • Severe back pain that is worse at night and that is not helped by changing position.
  • Recent unexplained weight loss
  • Changes in the shape of the spine

Possible signs of infection

  • Fevers, chills, rigors
  • Immunosuppression (HIV/ AIDS)
  • intravenous (IV) drug misuse
  • recent bacterial infection
  • penetrating or stab wound

Trauma – recent falls or accidents especially if you have a diagnosis of osteoporosis

  • Severe central pain, relieved by lying down
  • structural changes to the spine (change in shape)

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More common causes of severe back pain

Ok – so let's assume that you don’t have any of these lower back pain symptoms and that your doctor has checked you out. Sciatic nerve pain tends to cause symptoms of pain, numbness and weakness in one leg. If your pain is mostly central. That leaves us with the most common type of back pain which is called non-specific lower back pain and it can be dreadfully painful.

Often very minor back strains and sprains can cause really severe back pain.

The reason it is called non-specific is that it is difficult to pin point the exact cause of the problem. In my experience it is commonly a sore joint or ligament that can be the culprit. Regardless of the actual structure that is affected have seen several things that commonly happen

  1. The muscles surrounding the sore area go into spasm to protect the sore spot – this can be even more painful than the original problem

  2. You start to worry that the problem is serious and won't go away, this worry causes you to focus on the pain and can make it feel worse.

Tips for back pain relief

If you have got non-specific lower back pain the key is to try and control the pain so that you can return to a more normal daily routine. Pain has a really nasty habit of stopping you doing the things you would normally do and then inactivity can make the problem worse.

  1. Take effective pain medication – this won't cure the problem but will enable you to reduce severe pain so that you can get going again – and that will help in the long run. The most recent guidelines recommend starting with paracetamol, then moving to a non-steroidal anti-inflammatory drug and finally to weak opioids if these don’t help (Map of Medicine 1).

    Some recent research has shown that non-steroidal pain relief gel can be very effective ( 2.) Medication is personal to you, check with your doctor or pharmacist to make sure you get the most suitable type.

  2. Keep active for effective back pain relief It is now established wisdom that keeping on the move is better for you than bed rest. Try and keep gently active, using pain relief to help keep up and about (3)

  3. position of comfort for back pain reliefFind a position of ease that is most comfortable for you It is all very well trying to keep active but sometimes if you have severe pain it just gets on top of you. In the first few days I suggest that you alternate spending some time in a position of comfort with staying gently active. The positions illustrated on this sciatica page may be helpful for home back pain relief, experiment to find the one that suits you the most.

  4. Get some treatment for back pain from a physiotherapist or other health care provider. Sometimes seeing someone for back pain management can help with pain relief, - manipulation, massage and exercise have been shown to be helpful, at least in the short term.

  5. You can see some back pain relief stretching videos and exercises on this page.

  6. Make sure that your mattress is not causing a problem and think about your sitting position too.


1. Low back pain - initial management - The Map of Medicine - International.

2. Huang, Z.-J. et al. Topical application of compound Ibuprofen suppresses pain by inhibiting sensory neuron hyperexcitability and neuroinflammation in a rat model of intervertebral foramen inflammation. J Pain 12, 141-152 (2011).

3. Hagen, K.B., Hilde, G., Jamtvedt, G. & Winnem, M. Bed rest for acute low-back pain and sciatica. Cochrane Database Syst Rev CD001254 (2004).doi:10.1002/14651858.CD001254.pub2


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