Most back pain treatments are not equal. Guidelines and the 2018 Lancet series agree on a short list of things that help: information and reassurance, staying active and exercise. Medication has a limited, short-term role. Many popular treatments, from corsets to routine scans, have little or no benefit. This page ranks the options by evidence.
This guide is for common, non-specific back pain. Pain with bladder or bowel changes, saddle numbness, weakness in both legs, fever, significant trauma or a history of cancer needs medical assessment first. See red flags.
First line: recommended for nearly everyone
| Approach | Evidence |
|---|---|
| Education, reassurance and self-management | First line in the Lancet series and NICE12 |
| Staying active and at work where possible | Rest is overused; advice is to keep moving13 |
| Exercise | Recommended; NICE suggests considering group exercise of any type2 |
| Exercise with education to prevent recurrence | The only interventions with good evidence for prevention1 |
| A progressive walking programme | Reduced recurrences and doubled the time to the next episode4 |
See exercise therapy and walking for back pain.
Second line: sometimes useful
| Approach | Notes |
|---|---|
| Psychological approaches, such as CBT | Advised for persistent pain in the 2018 Lancet series;1 NICE withdrew its recommendation in 2026 after reviewing newer evidence2 |
| Manual therapy (manipulation, massage) | Only alongside exercise, not on its own2 |
| NSAIDs | Can be considered at the lowest dose for the shortest time, weighing stomach, kidney and heart risks2 |
Not recommended or low value
| Approach | Why |
|---|---|
| Paracetamol on its own | Not recommended by NICE for low back pain2 |
| Routine X-ray or MRI | Rarely changes management without red flags; see when imaging is useful |
| Belts, corsets, foot orthotics, traction | Not recommended by NICE2 |
| Acupuncture, TENS, ultrasound, interferential therapy | Not recommended by NICE2 |
| Opioids for chronic back pain, routine injections, early surgery | Overused worldwide relative to their benefit13 |
Neck pain
The neck follows the same pattern, with the strongest evidence for neck and shoulder strengthening in people with pain at work.5 See neck pain.
Putting it together
- Keep moving; avoid bed rest.
- Start gentle exercise and build it up over weeks. See strength training.
- Break up long sitting. See sitting breaks.
- Use medication briefly if needed, after checking with a pharmacist or doctor.
- Get assessed if pain is not improving after a few weeks, or straight away for red flags.
More on the condition itself: low back pain.
Footnotes
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Prevention and treatment of low back pain: evidence, challenges, and promising directions. 2018. ↩ ↩2 ↩3 ↩4 ↩5
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Low back pain and sciatica in over 16s: assessment and management (NICE guideline NG59). 2026. ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8
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The Lancet Series call to action to reduce low value care for low back pain: an update. 2020. ↩ ↩2
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Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence (WalkBack). 2024. ↩
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Workplace-based interventions for neck pain in office workers: systematic review and meta-analysis. 2018. ↩
General information, not medical advice. Every claim carries its source; where the evidence is thin, the page says so.Editorial policy · How we grade evidence · All sources · Disclaimer