Low back pain: what to do and when to see a doctor

A common problem, usually not serious

Pain in the lower back, called low back pain, is very common: in Belgium, about one person in five reports having had persistent back pain in the past twelve months. Most often it is non-specific low back pain: the pain comes from the muscles, joints or ligaments of the back, with no serious disease behind it. It can be very bothersome, but it usually gets better on its own, within a few days to a few weeks. It is called chronic low back pain when it lasts more than 12 weeks.

Stay active rather than staying in bed

Prolonged bed rest does not help you recover, and inactivity can slow recovery down. The Belgian guideline from the KCE (Belgian Health Care Knowledge Centre) advises you to continue your usual activities as much as possible:

• move regularly, even gently (walking, simple daily tasks);
• if the pain is severe, lie down for a while, then start moving again;
• increase your activities step by step, according to what your back allows;
• remember that feeling some pain when you move does not mean you are damaging your back.

Relieving the pain

Heat (hot-water bottle, heating pad) can reduce pain and discomfort a little during the first days, according to a Cochrane review. Use it alongside movement, never directly on the skin or while falling asleep, to avoid burns.

Medicines are not compulsory: they mainly help you stay active, at the lowest effective dose and for the shortest possible time.

• Anti-inflammatories (NSAIDs), such as ibuprofen or naproxen: they can be considered for a short period if you tolerate them. Ask your doctor or pharmacist first if you are over 65, have had a stomach ulcer, have kidney or heart disease, take a blood thinner (anticoagulant or aspirin), a diuretic or certain blood pressure medicines, or if you are pregnant (NSAIDs are not advised in the 2nd trimester of pregnancy and are contraindicated in the 3rd). A stomach-protecting medicine is sometimes needed.
• Paracetamol: taken alone, it does no better than a placebo in acute low back pain. The KCE recommends not offering it routinely as the only medicine, and the UK guideline (NICE) advises against using it alone. Your doctor may still combine it with another treatment.
• Weak opioids: only if NSAIDs are contraindicated, poorly tolerated or ineffective, for the shortest possible time, and not routinely for chronic pain.
• Muscle relaxants: the KCE does not recommend them, because their benefit is small compared with their side effects.

An X-ray or MRI? Usually not

Without a warning sign, an X-ray, CT scan or MRI changes neither the treatment nor the outcome: the KCE and NICE advise against routine imaging. It is considered when there is a warning sign, if significant pain persists after six weeks despite well-followed treatment, or before an injection or surgery.

When the pain goes down the leg (sciatica)

The pain may spread to the buttock and leg, sometimes with tingling or numbness: this is radicular pain, or sciatica. A nerve root is irritated, for example by a herniated disc. It also usually improves within a few weeks, with the same advice: stay active and relieve the pain. If it remains very severe, your doctor may discuss an injection; surgery is only discussed if other treatments have failed, usually after 6 to 12 weeks. Report any weakness in the leg or foot quickly.

Warning signs (“red flags”)

Rarely, back pain needs quick medical advice.

Call 112 or go to the emergency department straight away if you have:

• difficulty passing urine, or loss of control of urine or stools;
• loss of feeling between the thighs, around the genitals or the anus (“saddle anaesthesia”);
• marked weakness in a leg or foot (the foot “drops”, the leg gives way);
• severe pain after a major injury (fall from a height, accident);
• severe pain with cold or pale feet.

Contact your doctor the same day (outside opening hours: on-call doctor via 1733) if you have:

• fever, chills or night sweats;
• pain after a fall, even a minor one, if you have osteoporosis, have taken cortisone for a long time or are elderly;
• a weakened immune system, or if you inject drugs.

See a doctor without delay, in the following days, if:

• you have had cancer;
• you are losing weight for no reason or are unusually tired;
• the pain is severe at night, constant, or gradually getting worse;
• it is a first episode of back pain before age 18 or after age 55;
• the pain is still significant after six weeks despite well-followed treatment.

What can make the pain last (“yellow flags”)

Some factors increase the risk that the pain becomes chronic:

• believing that pain means the back is damaged, or expecting not to recover;
• being afraid to move and avoiding activities;
• relying mainly on passive treatments (rest, massage, heat);
• stress, anxiety or low mood;
• work you see as dangerous for your back, a lack of support, overprotective people around you or conflict-laden administrative procedures.

If the pain has not improved after about two weeks, your doctor can assess this risk with a short questionnaire and adapt your follow-up.

Physiotherapy and exercise

During the first two weeks, staying active is usually enough, without physiotherapy. If the pain persists or the risk of chronic pain is higher, a supervised exercise programme is the core of treatment. It is chosen according to your needs and preferences, as no type of exercise has been shown to be better. Manipulation, mobilisation or massage can help, but only in addition to exercise (manipulation should be avoided in sciatica). Lumbar belts, orthopaedic insoles, traction and electrotherapy are not recommended.

At Maison Médicale Parc Astrid, our physiotherapists work on site, together with your doctor, to build a programme adapted to you.

Work and medical certificate

Returning to work and your activities as soon as possible helps recovery: working is often a simple way to stay active. If your job is too physical for a few days, your doctor can write a certificate of incapacity for work, as short as possible, usually until the follow-up visit. A gradual return, with adapted tasks or hours, can be discussed with your employer or the occupational physician.

When the pain lasts more than three months

With chronic pain, the aim is to gradually get back to your activities. A programme combining exercise with a cognitive behavioural psychological approach can help. Our psychologists can support you in managing pain, stress and the fear of moving. If needed, your doctor will refer you to a multidisciplinary rehabilitation programme.

Your doctor in Anderlecht

At Maison Médicale Parc Astrid in Anderlecht, your general practitioner examines you, looks for warning signs and adapts treatment to your situation. See your doctor if the pain stops you from sleeping or doing your activities, or if it has not improved after two weeks. We welcome you in French, Dutch, English and Turkish.

Sources

• KCE – Low back pain and radicular pain: evaluation and management, report 287 (2017)
• KCE – Low back pain and radicular pain: development of a clinical pathway, report 295 (2017)
• Revue Médicale de Liège – Low back and radicular pain: which management in 2018? (2018)
• BCFI/CBIP – Belgian Commented Drug Formulary, 9.1 NSAIDs (2026)
• NICE – Low back pain and sciatica in over 16s, NG59 (2016, updated 2020)
• Cochrane – Pharmacological treatments for low back pain in adults (2023)
• Cochrane – Superficial heat or cold for low back pain (2006)