Lower back pain is usually managed with an assessment, advice to stay active and an individual rehabilitation plan. A scan or procedure is not automatically needed. Treatment depends on the symptoms, examination and effect on everyday life; new neurological symptoms or other warning signs require a different, sometimes urgent, pathway. [1] [2]
When back pain needs urgent help
Go to an emergency department for new difficulty passing urine, loss of bladder or bowel control, numbness around the genitals or anus, or pain with severe or worsening symptoms in both legs. Significant trauma also needs urgent assessment. Seek prompt medical advice for fever, feeling unwell, rapidly worsening pain or unexplained weight loss. Do not wait for a routine enquiry response when emergency symptoms are present. [2]
What the assessment looks for
Pain may come from several tissues, and sometimes no single structural cause can be identified. The consultation should distinguish back-dominant pain from leg pain associated with a spinal nerve root, and consider less common causes such as fracture, infection or inflammatory disease. [1] [2]
Describe what you can and cannot do: walking distance, sleep interruption, sitting tolerance and work tasks are useful starting points. Bring previous reports and scans, your medication list and a record of treatments already tried. Agree on a practical goal, such as returning to a walk or getting through a work session comfortably.
Do I need an X-ray or MRI?
Uncomplicated new back pain usually does not need immediate imaging. MRI may be appropriate when serious pathology is suspected or persistent symptoms make a procedure or surgery a realistic consideration. The useful question is whether the result would change care. ACR guidance supports this selective approach rather than routine scanning of every painful back. [3]
Treatment usually starts with an active plan
For chronic primary low back pain, WHO recommends care tailored to the individual. Education, structured exercise and selected physical or psychological approaches may form part of a combined plan. Psychological support addresses coping and the wider impact of pain; it does not mean the pain is imaginary. [4]
The plan should be manageable and reviewed. Ask which activities you can continue, how to progress exercise and when to return if symptoms change. Medicines require a separate benefit–risk discussion, particularly when there are other health conditions or several medicines in use. [1] [4]
When might a procedure or surgical opinion help?
A procedure needs a specific clinical rationale. NICE advises against spinal injections for nonspecific low back pain, while allowing a selected pathway for lumbar facet radiofrequency treatment after a positive diagnostic medial branch block. [1]
Recommendations are not uniform: a 2025 BMJ guideline recommends against common injections and ablation procedures for chronic non-cancer spine pain. Discuss this uncertainty as well as potential benefit, harms and alternatives. Surgical assessment is appropriate for some structural or neurological problems; it should not be delayed simply to complete a list of injections. [5]
Questions patients often ask
Does a painful back mean something is damaged?
Not necessarily. Pain severity alone does not identify its cause. The assessment considers the symptom pattern and warning signs, and decides whether further investigation would help. [2] [3]
Should I rest in bed?
Avoid prolonged bed rest. Keep moving within a tolerable range and ask for advice if activity causes substantial worsening or new neurological symptoms. [2]
How will we judge whether treatment is helping?
Agree on meaningful goals before starting. Pain scores can be useful, but also review sleep, movement, work and the activities that matter to you. Ask when the plan should change if those goals are not improving.
Related information
Evidence and further reading
- Low back pain and sciatica in over 16s: assessment and management — recommendations. NICE NG59; 2016; medicines recommendations updated 2020.
- Back pain. NHS; Reviewed 5 March 2026.
- ACR Appropriateness Criteria: Low Back Pain — 2021 Update. American College of Radiology; 2021.
- WHO releases guidelines on chronic low back pain. World Health Organization; 7 December 2023.
- Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ; 19 February 2025.
Evidence sources checked: 10 November 2026.
This information supports discussion with a healthcare professional and does not replace an individual assessment.