Back Pain

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Heping patients relieve back pain

From providing advice and information about self-help strategies, to pain relief medicines, signposting and apps, there is so much independent pharmacists can do to support their patients, says Steve Titmarsh...

Digital solutions for back pain management

Apps that provide quick and easy access to advice and information are being evaluated to see if they can help people manage back pain. Pharmacists can play their part too.

In its early value assessment, the National Institute for Health and Care Excellence (NICE) recommends five digital technologies for managing non-specific low back pain in people aged 16 and over. These can be used within the NHS once they receive appropriate regulatory approval and meet the standards within NHS England’s Digital Technology Assessment Criteria (DTAC).

The five recommended apps are:
🔹 getUBetter
🔹 Hinge Health
🔹 Kaia
🔹 Pathway through Pain
🔹 SelfBack

Ongoing research

NICE says that companies need to gather more information and evidence on various factors including:¹

• Pain and disability using the same outcome measure (Musculoskeletal Health Questionnaire)
• Quality of life using the same outcome measure (EQ‑5D‑5L)
• Patient characteristics like type and severity of back pain
• Time until return to daily activities
• Treatment adherence
• Adverse events related to using the technology
• Healthcare resource use, including GP and physiotherapy appointments
• Number of people who have been self-referred vs referred by a healthcare practioner for the technology
• Position of the technology in the care pathway
• Patients’ view on the effects of the technologies.

NICE has also identified five other technologies that can only be used in research

🔹Ascenti Reach
🔹Digital Therapist
🔹Flok Health
🔹Phio Engage
🔹Joint Academy

Potential benefits of digital technologies¹

• Rapid access to specialist advice and guidance
• Remote pain management support, including physical activity recommendations
• Access to psychological therapies through web-based applications and digital platforms.

Prevention

University Hospital Southampton NHS Foundation Trust offers advice on avoiding back pain. It states:²

• Avoid heavy lifting where possible
• Lift correctly – with feet shoulder-width apart, back and legs straight, hips and knees bent, arms and object close to the body
• Good posture – stand correctly with the back upright and core engaged
• Work at the right height – avoid unnecessary stooping
• Sleep on a firm bed
• Get out of bed properly – roll onto your side, bend your knees, swing both legs over the edge of the bed and push up on the elbow
• Sit correctly – with support for your back and thighs
• Exercise regularly (swimming being one of the best forms) – to strengthen back and abdominal muscles and keep the spine from getting stiff
• Move around and change positions often – avoid prolonged sitting
• Practice relaxation techniques to reduce tension and pain. There are many types of relaxation techniques from breathing exercises to meditation.  

Key takeaways: Good posture, regular exercise, careful lifting techniques and maintaining a healthy weight reduce the risk of back pain.³

Self-help

NICE advises non-invasive management of low back pain and sciatica for people aged over 16. They should be provided with advice and information like:

• Self-management strategies tailored to individual needs and capabilities
• Group exercise (biomechanical, aerobic, mind-body or a combination)
• Manual therapy (spinal manipulation, mobilisation, massage) which may be useful with or without psychological support
• Encouraging patients to resume normal activities as soon as possible.

Useful patient resources

📖 Backcare – a national charity that has information leaflets on workplace back pain; exercises for back pain; hot and cold therapies
📖 Keele University Start Back – ‘Your guide to back pain and what you can do about it’
📖 Versus Arthritis – booklets and exercise guides for back pain relief
📖 Chartered Society of Physiotherapy – for several resources on pain management

Pharmacist-recommended pain management options

• First-line treatment: A non-steroidal anti-inflammatory (NSAID) like ibuprofen, taken at the lowest effective dose for the shortest possible time
• Alternative: If ibuprofen is unsuitable, codeine with or without paracetamol may be considered for short-term use
• Heat or ice pack application can help ease pain symptoms.^5,6

Other therapies

• NHS England says there is currently insufficient evidence to support the use of cannabis-based products for managing chronic pain, although individual patients may feel otherwise.⁷ 
• University of Bath research found cannabidiol (CBD) products ineffective for treating pain.

Key analysis from the International Society for the Study of Pain review (2021)

• 16 trials examined various cannabidiol formulations across 12 different pain conditions in dosages of 6mg to 1600mg with treatment lasting from one dose to 12 weeks
• 15 out of 16 studies found CBD no more effective than a placebo.⁸

“CBD presents consumers with a big problem. It’s touted as a cure for all pain, but there’s a complete lack of quality evidence that it has any positive effects. It’s almost as if chronic pain patients don’t matter, and that we’re happy for people to trade on hope and despair.” 
- Professor Chris Eccleston, University of Bath

Non-recommended treatments (NICE):

• Foot orthotics
• Rocker sole shoes
• Belts or corsets.

References at Independent Community Pharmacist

1. National Institute for Health and Care Excellence (NICE). Digital technologies for managing non-specific low back pain: early value assessment. Health Technology Evaluation HTE16. Available at: NICE (Accessed February 2025).
2. University Hospital Southampton NHS Foundation Trust. Patient information factsheet: How to prevent back pain. At: UHS (Accessed February 2025).
3. NI Direct. Back pain. Available at: NI Direct (Accessed February 2025).
4. National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. NICE Guideline NG59. Available at: NICE (Accessed February 2025).
5. Clinical Knowledge Summaries (CKS). Back pain – low (without radiculopathy). Available at: CKS (Accessed February 2025).
6. NHS Inform. Back problems. Available at: NHS Inform (Accessed February 2025).
7. NHS England. Cannabis-based products for medicinal use (CBPMs). Available at: NHS England (Accessed February 2025).
8. Moore A, Straube S, Fisher E, Eccleston C. Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. J Pain. 2024;25(4):833–42.
9. University of Bath. CBD products don’t ease pain and are potentially harmful – new study finds. Available at: University of Bath (Accessed February 2025).