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Independent pharmacists are ideally placed to have early conversations with patients about back pain, as Kathy Oxtoby explains…

“Back pain is a very popular category for pharmacy,” says Lila Thakerar, the superintendent pharmacist at Shaftesbury Pharmacy in Harrow.

For those whose back pain is non-urgent, with no complications, pharmacy is “the first port of call”, for people wanting simple advice, she says.  

Patients will typically visit their GP or emergency department if their back pain is severe.

“However, if they are unable to get an appointment with their GP surgery, they may come to the pharmacy for an initial assessment, and if necessary, we will signpost them to another healthcare service, such as a GP, or A&E,” she says.

“Back pain often stems from muscle strain, poor posture, prolonged sitting, lifting injuries, stress or inflammation, leading many to seek over‑the‑counter relief,” says Heidi Wright, the Royal Pharmaceutical Society (RPS) England’ practice and policy lead.

“Pharmacists are well placed to have early conversations with patients, ruling out red flag symptoms and identifying when referral to a GP, NHS 111 or urgent care is needed,” she says.

There are many causes of back pain, says Gurvinder Najran, the lead pharmacist at The Greens Health Centre in Dudley, who also teaches pharmacy undergraduates at Keele University. 

Sciatica is a medical condition that can cause back pain, numbness, or weakness that radiates along the sciatic nerve, from the lower back down through the buttocks and legs, he says.¹

Sciatica is caused by irritation or compression of the nerve roots in the spine, poor lifting techniques, lack of back support during prolonged periods of sitting, poor posture, obesity – causing more stress on the lower back of the sciatic nerve – and injury causing irritation to the sciatic nerve.

Sciatica is also caused by inflammatory conditions such as rheumatoid arthritis, osteoarthritis, and smoking, he says.¹

Spondylosis is another source of back pain. This is caused by age-related wear and tear on spinal discs and joints, leading to dehydration, disc thinning, and bone spur formation.

Other risk factors include past neck injuries, repetitive strain from jobs, smoking, and obesity, he says.² Neuropathic pain is chronic pain from damaged or diseased nerves.

“It feels like burning, shooting, or electric shocks, often with numbness, tingling, or extreme touch sensitivity, unlike typical pain from injury,” says Mr Najran. It stems from nerve damage, diabetes, a post infection from shingles, or alcoholism, he says.³

Another common cause of back pain is back strain - an injury to a muscle or tendon which can be triggered by, for example, poor lifting techniques, he says.⁴

Approaches to helping people with back pain

Pharmacists can provide “safe, evidence-based options tailored to the individual, considering their overall health, medicines they are taking and the risk of ongoing or chronic pain”, says Ms Wright.

“This may include advising on the appropriate use of NSAIDs such as ibuprofen, topical anti-inflammatory gels, creams or patches for localised relief, and the safe use of heat or cold therapy to ease muscle spasms and inflammation,” she says.  

“Pharmacists can explain how these treatments work, how to use them safely and what side effects to look out for.”

The National Institute for Health and Care Excellence (NICE) says to consider oral NSAIDs for managing low back pain, “taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity, and the person's risk factors, including age”.⁵  

Topical NSAID treatments may be more suitable for patients, as they are less systemically absorbed compared to oral therapies, thereby minimising exposure to side effects, says Mr Najran.

“However, caution is still necessary when using these treatments,” he says. “Pharmacists can access patients' Summary Care Records (SCR) to evaluate the appropriateness of NSAIDs for individual patients.”

Additionally, they should refer to the Summary of Product Characteristics for the relevant NSAID preparation to ensure clinical safety and suitability for the patient in question, he says.⁶

Pharmacists could also suggest having psychological support, such as cognitive behavioural therapy (CBT) or counselling to help patients manage their pain, says Ms Thakerar.

Self-care options 

Self-care options for simple back pain include gentle exercises and stretches, she says. Pharmacists can give patients suggestions about exercises, print out information for them, and direct them to relevant websites.

“Beyond medicines, pharmacists can advise on staying active with gentle movement, building activity gradually, and using posture, safe lifting techniques, supportive footwear and healthy weight management to reduce recurrence,” says Ms Wright. 

“Walking, swimming or light yoga can improve posture, flexibility and core strength.”

Mr Najran says a “good resource” is the ‘Live Well with Pain’ website [https://livewellwithpain.co.uk/] to support non-pharmacological options in managing pain.

Patients can also access links to videos on the NHS website regarding exercise and stretches they can do to help prevent aches and pains, he says.⁷

“If pain persists beyond a few weeks of self-care, severely impacts daily life, or recurs, pharmacists will signpost to physiotherapy, musculoskeletal services or structured exercise programmes in line with NICE guidance,” says Ms Wright.  

‘Red flags’ include severe back pain, numbness in the lower part of the back, if the patient has bowel or bladder problems, or if the pain is worse at night, and they should be referred to their GP or A&E, she says. 

Other red flags include if the patient has a fever with back pain, or has chronic back pain with weight loss, and they should be immediately referred to A&E, she adds. 

Mr Najran advises that comprehensive details on red flags are to be discussed with patients, and to also refer them to the NHS website.⁷ [https://www.nhs.uk/conditions/back-pain/]

“Patients should receive this link where possible after consultations to understand when to seek GP appointments or NHS 111 assistance,” he says.

When supporting patients with back pain it is important to "ensure a thorough history taking has been completed to provide an appropriate action plan for them, depending on the symptoms and causes/risk factors”, he adds.  

Pharmacists can also educate patients about the risk factors that might be attributing to their specific back pain, such as obesity, smoking, and poor lifting, to help address reducing the risk of back pain, he says.

Ms Thakerar says that with any consultations where patients present with back pain, the general advice pharmacists should give is “they need to stay active”.

The patient needs to see a GP if their pain persists for more than a few weeks, she says. “It’s important to be aware that there are boundaries that we have in treating back pain and we must not surpass those boundaries – we must refer if necessary.” 

To avoid surpassing those boundaries, she says pharmacists should not treat patients with back pain for months at a time. And if there are associated symptoms, such as fever or bladder issues, “do not treat them separately – they could be associated with back pain”.

References 

1. Olenick C and Wiginton K (2025). Sciatica. WebMD.

 https://www.webmd.com/back-pain/sciatica-symptoms

2. Mayo Clinic Staff (2025) Cervical spondylosis. Mayo  Clinic. 

https://www.mayoclinic.org/diseases-conditions/cervical-spondylosis/symptoms-causes/syc-20370787

3. Cleveland Clinic (2023) Neuropathic Pain. 

https://my.clevelandclinic.org/health/diseases/15833-neuropathic-pain

4. Cleveland Clinic (2018) Back Strains and Sprains.

 https://my.clevelandclinic.org/health/diseases/10265-back-strains-and-sprains

5. National Institute for Health and Care Excellence (NICE) (2020) Low back pain and sciatica in over 16s: assessment and management. NICE guideline:NG59.  https://www.nice.org.uk/guidance/ng59 Published 30 November 2016. Last updated 11 December 2020.

6. Shi, C. et al. (2023) Multidisciplinary Guidelines for the Rational Use of Topical Non-Steroidal Anti-inflammatory Drugs for Musculoskeletal Pain (2022). Journal of Clinical Medicine, 12(4), 1544. https://www.mdpi.com/2077-0383/12/4/1544

7. NHS (2022) Back pain. https://www.nhs.uk/conditions/back-pain/