• Wear and tear (degenerative disease) of the bones, ligaments, or disks in your back.
• Inflammation and stiffness in your back (arthritis).

People who have chronic back pain often go through certain periods in which the pain is more intense (flare-ups). Many people can learn to manage the pain with home care.

Follow these instructions at home:

Pay attention to any changes in your symptoms. Take these actions to help with your pain:

Managing pain and stiffness

• If directed, apply ice to the painful area. Your health care provider may recommend applying ice during the first 24–48 hours after a flare-up begins. To do this:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• If directed, apply heat to the affected area as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
• Try soaking in a warm tub.

Activity

• Avoid bending and other activities that make the problem worse.
• Maintain a proper position when standing or sitting:
  • When standing, keep your upper back and neck straight, with your shoulders pulled back. Avoid slouching.
  • When sitting, keep your back straight and relax your shoulders. Do not round your shoulders or pull them backward.
• Do not sit or stand in one place for long periods of time.
• Take brief periods of rest throughout the day. This will reduce your pain. Resting in a lying or standing position is usually better than sitting to rest.
• When you are resting for longer periods, mix in some mild activity or stretching between periods of rest. This will help to prevent stiffness and pain.
• Get regular exercise. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe. Always use proper lifting technique, which includes:
  • Bending your knees.
  • Keeping the load close to your body.
  • Avoiding twisting.
• Sleep on a firm mattress in a comfortable position. Try lying on your side with your knees slightly bent. If you lie on your back, put a pillow under your knees.

Medicines

• Treatment may include medicines for pain and inflammation taken by mouth or applied to the skin, prescription pain medicine, or muscle relaxants. Take over-the-counter and prescription medicines only as told by your health care provider.
• Ask your health care provider if the medicine prescribed to you:
  • Requires you to avoid driving or using machinery.
  • Can cause constipation. You may need to take these actions to prevent or treat constipation:
    • Drink enough fluid to keep your urine pale yellow.
    • Take over-the-counter or prescription medicines.
    • Eat foods that are high in fiber, such as beans, whole grains, and fresh fruits and vegetables.
    • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain that is not relieved with rest or medicine.
• Your pain gets worse, or you have new pain.
• You have a high fever.
• You have rapid weight loss.
• You have trouble doing your normal activities.

Get help right away if:

• You have weakness or numbness in one or both of your legs or feet.
• You have trouble controlling your bladder or your bowels.
• You have severe back pain and have any of the following:
  • Nausea or vomiting.
  • Pain in your abdomen.
  • Shortness of breath or you faint.

Summary

• Chronic back pain is back pain that lasts longer than 3 months.
• When a flare-up begins, apply ice to the painful area for the first 24–48 hours.
• Apply a moist heat pad or use a heating pad on the painful area as directed by your health care provider.
• When you are resting for longer periods, mix in some mild activity or stretching between periods of rest. This will help to prevent stiffness and pain.