What is the best way to treat back pain?

Summary of a HEN network member’s report

The issue

Low back pain affects up to 80% of all people at some time during their lives. Back pain has a significant economic impact on individuals and on society. The direct health care costs and those resulting from sick leave and early retirement due to back pain are annually over three times higher than the costs for all cancers.


In the great majority of people, back pain is not a serious disease or that one should curtail normal daily activities. On the contrary, studies show that healing is promoted by staying active, returning to work, and exercising at an appropriate and increasing intensity. Anti-inflammatory and muscle relaxant drugs offer effective pain relief. In the great majority of cases, acute back pain clears up within two weeks with such a regimen.

A thorough medical history and physical examination at the primary care level are important for relieving anxiety related to the pain. These examinations allow identification of the few patients who should be referred to a specialist for examination and treatment for specific causes of pain, such as severe infection, specific rheumatic disease, suspected cancer, or other severe conditions. However, in many cases, complicated diagnostic procedures are provided, and many of these lead to interventions that are not indicated. Radiographic (X-ray) studies are of limited value. There are many diagnostic and therapeutic procedures in widespread use that have not been shown to be of any benefit patient, while some – such as bed rest and sick leave – are actually harmful.

Back pain and its consequences are not isolated physical problems, but are associated with social, psychological, and workplace-related factors such as stress, worry, and anxiety; effective prevention and treatment must take these into account. Dealing with this situation can play a decisive role in preventing the development of chronic back pain.

Policy considerations

Many methods are used in the diagnosis and treatment of back pain despite evidence that they do not benefit the patient. The appropriateness of subsidizing ineffective methods of back pain diagnosis and treatment with public funds deserves further investigation and action.

The views expressed in this summary are based on a publication of a HEN Network member agency and do not necessarily represent the decisions or stated policy of WHO/Europe.