Low back pain with referred pain can vary widely with regards to severity and quality. It tends to be achy, dull and migratory (moves around). It tends to come and go and often varies in intensity. It can result from the identical injury or problem that causes simple axial back pain and is often no more serious.
Area of Pain Distribution
Referred pain is usually felt in the low back area and tends to radiate into the groin, buttock and upper thigh. The pain often moves around, and rarely radiates below the knee. This type of low back pain is not as common as axial low back pain or radicular pain sciatica.
See What You Need to Know About Sciatica
Referred pain is analogous to the pain that radiates down the left arm during a heart attack. It is the result of the extensive network of interconnecting sensory nerves that supply many of the tissues of the low back, pelvis and thigh.
An injury to any of these structures can cause pain to radiate – or be “referred” - to any of the other structures. It is important to understand that this type of pain is not due to “pinched nerves”.
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Diagnosis of Referred Low Back Pain
Unfortunately, the brain cannot determine the specific source of the pain. A careful history and physical exam by an experienced spine specialist can usually distinguish this type of pain from radicular pain, or pain that radiates down the leg along the specific course of a compressed spinal nerve. The distinction between referred pain and radicular pain is critical because the treatment of the two types of pain varies considerably.
Treatment of Referred Low Back Pain
In This Article:
Infographic:
5 Simple Back & Pelvic Stretches forSciatica Pain Relief
(larger view)
In general, referred pain is treated with the same types of nonsurgical care as axial back pain and will frequently diminish as the low back problem resolves. Once the possibility of a serious underlying medical condition as the cause of a patient’s low back pain is ruled out, treatment of referred low back pain is non-surgical and may include one or a combination of the following:
- A short period of rest (e.g. one or two days)
- Physical therapy, active exercise and stretching
- Ice packs and/or hot pads
- Appropriate medications for pain relief
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If the above treatments do not successfully reduce the patient’s pain to a manageable level, then additional non-surgical treatments may be tried. Laminectomy and discectomy surgery (back surgery aimed at decompressing the spinal nerve sac or individual spinal nerve roots) are often unsuccessful in treating referred pain. For cases of chronic severe low back pain, with or without referred leg pain, further testing and evaluation with discography (injection of the discs to determine if they are the pain generators) may be considered depending upon the treatment options being considered by the treating spinal specialist.
Sciatica is where the sciatic nerve, which runs from your lower back to your feet, is irritated or compressed. It usually gets better in 4 to 6 weeks but can last longer. If you have sciatica, your: may feel: Your symptoms may be worse when moving, sneezing or coughing.Check if you have sciatica
You may also have back pain, but it's not usually as bad as the pain in your bottom, leg or foot.
Information:
You probably do not have sciatica if you only have back pain.
How you can ease the pain yourself
Sciatica usually gets better in 4 to 6 weeks, but it can sometimes last longer.
To help relieve your pain and speed up recovery:
Do
carry on with your normal activities as much as possible
regular exercises for sciatica
start gentle exercise as soon as you can – anything that gets you moving can help
hold heat packs to the painful areas – you can buy these from pharmacies
ask your pharmacist about painkillers (paracetamol is unlikely to help and it's not clear how much NSAIDs help with sciatica)
put a small, firm cushion between your knees when sleeping on your side, or several firm pillows underneath your knees when lying on your back
Don’t
do not sit or lie down for long periods – even if moving hurts, it's not harmful and can help you get better faster
do not use hot water bottles to ease the pain – you could scald yourself if your skin is numb
Non-urgent advice: See a GP if the pain:
- has not improved after trying home treatments for a few weeks
- is getting worse
- is stopping you doing your normal activities
Immediate action required: Go to A&E or call 999 if you:
- have sciatica on both sides
- have weakness or numbness in both legs that's severe or getting worse
- have numbness around or under your genitals, or around your bottom (anus)
- find it hard to start peeing, cannot pee or cannot control when you pee – and this is not normal for you
- do not notice when you need to poo or cannot control when you poo – and this is not normal for you
These could be symptoms of a serious back problem that needs to be treated in hospital as soon as possible.
Treatments from a GP
If you have sciatica, a GP may:
- suggest exercises and stretches
- prescribe painkillers
They might also refer you for:
- physiotherapy – including exercise advice and techniques like massage (manual therapy)
- psychological support – to help you cope with the pain
Physiotherapy is free of charge on the NHS throughout the UK, but waiting times can be long. You can also get it privately.
Other treatments for sciatica
If your pain is severe and treatments from a GP have not helped, they may refer you to a hospital specialist for:
- painkilling injections
- a procedure to seal off some of the nerves in your back so they stop sending pain signals
- surgery – an operation called decompression surgery can sometimes help relieve sciatica
How to stop sciatica coming back
To reduce the chances of getting sciatica again:
Do
stay active – take regular exercise
use a safe technique when lifting heavy objects
make sure you have a good posture when sitting and standing
sit correctly when using a computer
lose weight if you're overweight
Don’t
do not smoke – smoking can increase your risk of getting sciatica
Causes of sciatica
Sciatica happens when something presses or rubs on the sciatic nerve.
Causes include:
- a slipped disc (the most common cause) – when a soft cushion of tissue between the bones in your spine pushes out
- spinal stenosis – narrowing of the part of your spine where nerves pass through
- spondylolisthesis – when one of the bones in your spine slips out of position
- a back injury
Video: What is sciatica?
This animation explains what sciatica is and what causes it.
Media last reviewed: 3 October 2020
Media review due: 3 October 2023
Page last reviewed: 08 September 2020
Next review due: 08 September 2023