We hear a version of the same sentence most weeks in the clinic. “I’ve had low back pain for a while, and it’s got that bad now that the tablets aren’t working anymore.”

It’s usually said with a bit of embarrassment, as though the person has done something wrong. They haven’t. Reaching for Panadol or Nurofen when your back hurts is the most reasonable thing in the world. It’s what the packaging suggests, what most of us grew up watching our parents do, and often what gets you through a work day.

The problem is what happens when the tablets become the plan rather than a stopgap. Pain is information. It’s your body telling you that something isn’t coping, and turning the volume down on that message doesn’t change what’s generating it. When the same pain keeps coming back and the same dose stops touching it, that’s worth taking seriously.

Back problems are one of the most common health conditions in the country. The Australian Institute of Health and Welfare estimates that around 4.0 million Australians, roughly 16% of the population, were living with back problems in 2022. So this is not a niche complaint, and there’s a substantial body of research on what actually helps. Some of what that research says about common pain medication is genuinely surprising.

Before going further, one thing needs to be clear. This article is not medical advice, and nothing here is a recommendation to start, stop or change any medication. That conversation belongs with your GP or pharmacist, who know your history. What we can talk about is what the evidence shows, and what the alternatives look like.

 

What Is Back Pain?

Back pain is a symptom rather than a diagnosis. It describes discomfort anywhere along the spine, from the base of the skull to the tailbone, and it can arrive as a sharp catch when you bend, a dull ache that builds through the afternoon, or a stiffness that only really announces itself when you get out of the car.

The low back is the most commonly affected area, which makes sense given how much load it carries and how many hours most of us now spend sitting.

Clinicians usually sort back pain a few ways.

By duration. Acute back pain comes on suddenly and generally settles within a few weeks. Subacute sits in the six to twelve week range. Chronic back pain is pain that persists beyond three months, and it’s the group most likely to end up in a long relationship with the medicine cabinet.

By what’s driving it. The large majority of cases are what’s called non-specific mechanical back pain, meaning the pain comes from how the joints, muscles and soft tissues of the spine are moving and loading rather than from a single identifiable injury. A smaller group involves nerve involvement, where a nerve root is irritated or compressed and the pain refers down the leg, often with pins and needles or weakness. A small minority comes from a specific underlying condition, which is exactly why an assessment matters.

Some back pain needs a doctor rather than a chiropractor, and quickly. If your pain follows a significant fall or accident, comes with unexplained weight loss or fever, involves numbness around the groin or loss of bladder or bowel control, or leaves you with progressive weakness in a leg, see a GP or go to an emergency department. Those are the situations where nobody should be self-managing.

 

Causes of Back Pain

In practice, most of the mechanical back pain we see traces back to one or more of the following.

Prolonged sitting and desk work. The spine is built to move and change position. Eight hours in a chair loads the same structures continuously, and the surrounding muscles adapt to that shape rather than to movement.

Posture and habitual loading patterns. How you sit, stand and carry things determines where load concentrates. If you’d like a practical starting point, we’ve written a guide to assessing your own posture that’s worth working through.

Joint restriction. When a spinal joint isn’t moving through its normal range, the segments above and below take up the slack. They end up doing more work than they were designed for, and that’s frequently where the pain shows up.

Weak or deconditioned supporting muscles. The deep core and gluteal muscles stabilise the lower back. When they’re not pulling their weight, other structures compensate.

Lifting technique and sudden overload. The classic “I just bent over to pick up a sock” episode is rarely about the sock. It’s usually the last straw on a back that has been quietly struggling for months.

Old injuries that never fully resolved. A sports injury or car accident from years ago can leave altered movement patterns behind long after the original pain has gone.

Stress and poor sleep. Both increase muscle tension and lower pain tolerance, which is why a stressful month at work so often coincides with a flare-up.

 

Solutions to Back Pain

The principle that guides everything below is straightforward. If you treat the symptom, you get relief. If you treat the source, you get change.

Both have their place. There’s nothing noble about being in unnecessary pain, and short-term relief can be exactly what lets you keep moving, which itself aids recovery. The trouble starts when relief becomes the entire strategy and the underlying mechanical problem is left to carry on unaddressed for years.

 

Panadol or Nurofen: What the Evidence Actually Shows

This is where most people are surprised, so it’s worth going through carefully.

Paracetamol. A large systematic review and meta-analysis published in the BMJ in 2015 by Machado and colleagues pooled randomised placebo-controlled trials of paracetamol for spinal pain and osteoarthritis. For acute low back pain it found paracetamol was no better than placebo on pain, disability, or quality of life. Speaking about the findings at the time, the lead author put it plainly: “Paracetamol has been widely recommended as being a safe medication, but what we are saying now is that paracetamol doesn’t bring any benefit for patients with back pain.” For osteoarthritis of the hip and knee, the benefit was real but small enough to be clinically unimportant.

Anti-inflammatories. The same research group looked at NSAIDs, the category Nurofen sits in, in a 2017 review in the Annals of the Rheumatic Diseases. Here the picture is different. NSAIDs did outperform placebo for spinal pain, so the anti-inflammatory effect is doing something a plain analgesic isn’t. But the size of that effect was modest, only about one in six people treated got a meaningful benefit they wouldn’t have had otherwise, and the reviewers noted a markedly higher rate of gastrointestinal side effects. Anti-inflammatories are also not suitable for everyone, particularly people with stomach, kidney, heart or blood pressure issues, which is a decision for your GP or pharmacist rather than the supermarket aisle.

Stronger options. It’s worth knowing that escalating doesn’t necessarily help either. The Australian-led OPAL trial, published in The Lancet in 2023, tested opioids against placebo for acute low back and neck pain and found no significant difference in pain at six weeks, with worse outcomes on some measures in the opioid group.

None of that means medication has no role. Used briefly, under guidance, it can take the edge off enough to let you stay active while the underlying issue is dealt with. What the evidence doesn’t support is treating tablets as the long-term answer, and this is precisely what international guidance now reflects. The 2018 Lancet series on low back pain recommends non-pharmacological approaches as first-line care, with medication in a supporting role.

 

Other Options Worth Considering

Keep moving. The old advice to rest in bed has been thoroughly overturned. Staying as active as your pain reasonably allows is now the standard recommendation across every major guideline.

Targeted exercise and strengthening. Building capacity in the muscles that support your spine addresses one of the more common underlying causes directly.

Manual therapy. Hands-on treatment aimed at restoring normal joint movement, which is where chiropractic care sits.

Heat and ice. Modest, temporary, and useful for symptom management alongside everything else.

Addressing your setup. Desk height, chair, monitor position and how long you go before standing up all shape the load your back carries daily.

Sleep and stress management. Less obviously mechanical, but both influence how much pain you experience and how well you recover.

Your GP. If pain is persistent, severe, or accompanied by any of the warning signs listed earlier, a medical assessment comes first.

How Chiropractic Care Can Help With Back Pain

Chiropractic care is concerned with how the joints of the spine move and how well the surrounding structures support them. Where a tablet reduces the sensation of pain, an adjustment aims at the mechanical dysfunction generating it.

The evidence here is honest rather than spectacular, and we’d rather present it that way. A 2019 BMJ systematic review by Rubinstein and colleagues found spinal manipulative therapy produced similar improvements in pain and function to other recommended treatments for chronic low back pain, with no serious adverse events reported in the trials reviewed. It is a legitimate option within the broader group of approaches that work, not a miracle cure, and anyone claiming otherwise is overselling.

If you haven’t been to a chiropractor before, here’s roughly how it goes.

1. History. We start with the story. When the pain began, what makes it better or worse, what you do for work, previous injuries, what you’ve already tried. This is often where the cause becomes apparent.

2. Physical assessment. We look at how you move, test the range of motion at individual spinal segments, check posture and gait, and run orthopaedic and neurological tests where they’re relevant. If anything suggests your problem is outside our scope, we refer you on. That’s part of the job.

3. Explanation. You get told what we found and what we think is driving it, in plain language. Understanding why your back hurts changes how you manage it.

4. Treatment. Adjustments to restore movement at restricted joints, usually alongside soft tissue work on the muscles that have been compensating.

5. What you do between visits. Specific exercises, changes to your desk setup, adjustments to how you lift or sit. This part matters as much as anything that happens in the clinic, because the hours you spend outside it are where most of the loading occurs.

6. Review. We reassess, track what’s changed, and adjust the plan. The goal is to get you to the point where you don’t need us regularly.

 

The Short Version

Educating people about this is one of the harder parts of the job, because the message runs against a habit most of us formed early. Painkillers conceal a symptom. They don’t repair the thing producing it, and the research on the two most common ones is far less flattering than the packaging implies.

The most useful thing you can do is act early. The patients who arrive saying the tablets have stopped working are almost always describing a problem that has been building quietly for a long time, and problems addressed at the point they first appear are far easier to resolve than ones left to settle in for years.

Talk to your GP about anything medication-related. And if your back keeps flaring up, or you’ve been managing it with tablets for longer than you’d like to admit, come and get it looked at properly.

Book an assessment at Lamp Chiropractic and let’s find out what’s actually causing it.