What to Do When Back Pain Strikes: A Calm Guide to Acute Episodes
Disclaimer: This blog is not medical advice. If you're experiencing severe back pain, it's important to get a proper clinical assessment—especially if you have leg weakness, numbness, incontinence, or a history of trauma. But if you've suddenly found yourself stuck on the floor, wondering what to do before you can get help, here are some principles that might guide you
1. Don’t Panic
The intensity of pain does not always reflect the severity of injury. It’s common to feel excruciating pain from the lower back without any serious tissue or bony damage. In fact, studies show little to no correlation between how bad the pain feels and what’s actually going on structurally. Your spine is strong and resilient—this doesn’t mean you're broken.
2. Most Back Pain Gets Better
The vast majority of acute low back pain resolves within 6–8 weeks, no matter what you do to it. It’s not uncommon for it to feel terrible at the start, but that doesn’t mean it will stay that way. The natural course of most back pain is improvement.
3. Breathe
When you’re in severe pain, it’s easy to breathe fast and shallow—which activates your body’s fight-or-flight system and ramps up your pain perception. Slowing your breathing helps calm your nervous system and reduce pain intensity.
One technique I’ve found helpful personally (even when I lay waiting for help for an hour after breaking my leg badly) is box breathing: inhale for 4 seconds, hold for 4, exhale for 4, hold for 4. Repeat.
Some people prefer an exhalation focussed pattern i.e breathing out for twice as long as you breathe in.
Either way, focus on breathing into your belly - this gets you diaphragm and spine stabilisers working. It can make a real difference.
4. Keep Moving—Gently
Lying completely still in bed with painkillers might feel like the only option—but it’s actually one of the worst things you can do. Movement helps your brain process pain differently and keeps your body from seizing up.
Even if walking is too much, try gentle floor movements or crawl around on hands and knees if needed. Do a little, rest, change position, repeat. Listen to your body—but don’t give in to total immobility.
5. Reassurance Is Powerful
One of the strongest tools in recovery is knowing you are not fragile. Your spine is not easily damaged. Fear and anxiety can amplify pain—so understanding that pain doesn't always mean harm is vital. This is a core message in all modern back pain guidelines.
6. Scans Aren’t Always Helpful
Unless there are specific red flags (like trauma, cancer history, or neurological symptoms), early imaging—like MRIs or X-rays—often shows “abnormalities” that are normal for your age and not actually related to your pain. They can increase fear and lead to unnecessary treatments. Good care starts with a good history and clinical reasoning—not a scan.
7. Stay Engaged in Life (As Much As You Can)
You might have to modify how you do things—but don’t disappear into bed and wait to feel better. Staying engaged in work, daily routines, or even small tasks helps you recover faster. Movement and purpose send strong signals to your brain and body that you’re okay—and that matters.
8. Use Medications Sparingly
Painkillers might help take the edge off—but they won’t fix the problem, and most guidelines now recommend using them cautiously. Opioids are not recommended, and even anti-inflammatories should be used short-term. Think of meds as a temporary aid while you focus on active recovery.
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In Summary
Severe back pain is awful—but it’s also usually temporary and not dangerous. If you can remember just a few things: stay calm, breathe, move gently, and seek reassurance from someone who knows what they’re doing. Most importantly, trust that you will get better.