Where to start

Most back and neck pain is not caused by anything dangerous. A few symptoms are different, and they need prompt care.

Call 911 right away if any of these come on suddenly, even if they get better or go away: weakness or numbness in the face, an arm or a leg, especially on one side of the body; trouble speaking or understanding speech; trouble seeing in one or both eyes; or sudden dizziness, loss of balance or trouble walking. These can be signs of a stroke. They need emergency care whether or not you also have back or neck pain, and they come before any same-day advice below.

Get emergency care now (call 911 or go to an emergency department) for back or neck pain with any of these:

• Not being able to pee, or new trouble controlling your bladder or bowels.
• New numbness in the groin, genitals or around the anus, or in both buttocks or both inner thighs (the area that would touch a saddle). This includes new numbness when you wipe, or new loss of feeling during sex.
• Weakness in both legs or both arms, weakness that is getting worse quickly, or sudden trouble walking.
• Pain that starts after a serious fall, a car crash, or another major injury.
• Neck pain with a sudden, severe headache, or with signs of a stroke such as loss of balance, double vision, a drooping face, or trouble speaking.
• A fever with a stiff neck, a severe headache, confusion, or new weakness or numbness.
• Back pain with chest pain or trouble breathing, or a sudden, severe tearing pain in the back or belly.

Call your clinician the same day for back or neck pain with any of these:

• A fever or chills, or feeling very unwell.
• A history of cancer, or weight loss you can’t explain.
• A weakened immune system, a recent serious infection, or injected drug use.
• Severe pain that is there all the time, including at night, and does not ease when you change position.
• New clumsiness in your hands, new trouble with balance, or new numbness in both arms or both legs. If these come on suddenly or get worse quickly, get emergency care.
• Pain after a minor fall or strain in someone with thin bones (osteoporosis) or long-term steroid use.
• New weakness in one arm or one leg that came on gradually, such as a foot that drags or slaps when you walk, and is not getting worse. If it came on suddenly, call 911 instead.
• Pain, numbness or tingling going down both legs. It is an emergency if it comes with any change in your bladder, bowels, sexual feeling, or the saddle area.

• Back pain is very common. Most adults have it at some point.
• For most people, back pain is not caused by a serious disease, and often no single cause can be pinned down.
• Most people with a new episode improve a lot within the first six weeks. Back pain often comes back from time to time, and for some people it lasts longer.
• Scans often show wear, bulges, and other changes in people who have no pain at all, and these changes become more common with age. A finding on a scan doesn’t always explain the pain.
• Staying as active as you comfortably can usually helps more than resting in bed.

This is the usual shape of non-surgical care, not a prescription. Your own plan may skip steps, repeat them, or run several at once.

• Self-care and staying active. In the first weeks, many people use heat, gentle movement, and short-term pain relief while the pain settles. More on staying active, heat and cold.
• Movement with a guide. If pain lingers or keeps coming back, physical therapy and exercise-based programs are often the next step. More on physical therapy and yoga, tai chi and Pilates.
• Hands-on and complementary care. Some people add massage, spinal manipulation, or acupuncture. Guidelines list these as options, mostly for short-term relief. More on chiropractic care, massage, acupuncture and cupping.
• Medicines. Guidelines usually put non-drug options first, and use medicines as an add-on to help you keep moving. More on topical pain relievers, acetaminophen, anti-inflammatories, muscle relaxants, gabapentin and pregabalin and antidepressants used for pain.
• Injections and procedures. For some kinds of pain, such as pain that travels down a leg or pain from specific joints in the spine, a specialist may offer an injection or a procedure such as radiofrequency ablation. These are usually used alongside the steps above, not instead of them. More on epidural steroid injections, facet joint injections, radiofrequency ablation and SI joint injections.
• Everyday health, all along the way. Sleep, stress, mood, weight, and smoking are all linked with how pain feels and how long it lasts. More on weight and smoking and braces and collars.

If pain does not improve with non-surgical care, or certain nerve problems develop, your clinician may suggest seeing a spine surgeon. Seeing a surgeon does not always mean having surgery, and surgeons often recommend continuing non-surgical care.

• What do you think is behind my pain, and how sure can we be?
• Which warning signs should I watch for?
• What can I do on my own this week?
• Which options make sense to try first, and why?
• How will we know if something is working, and when should I check back?
• What happens if I wait and see for now?

NonOp explains options in general terms, so you can have a better conversation with your clinician. It can’t examine you, read your scans, or know your history. So it can’t tell you what is causing your pain or which option fits your situation. Your own clinician can help with that.