LogoSam
Part of the series: Living with Chronic Low Back Pain →
11 min readSanoLabs Editorial

When Is Back Pain Chronic? What to Log Between Visits

When back pain counts as chronic, what to write down between appointments, what your GP or physio will ask, and which symptoms need a doctor now.

chronic low back painback painpain diarysymptom diarydoctor appointmentphysiotherapy
On this page

Your back has been hurting for weeks, maybe months, and by the appointment it has blurred into "it comes and goes". NICE counts low back pain as chronic once it has lasted three months or longer, even if the intensity rises and falls. In Sam's symptom diary you log lower back pain per day as mild, moderate or severe, and steps and exercise minutes from Apple Health are in the same app. Below: when it counts, what to write down, what your GP or physio will ask, and which symptoms need a doctor now.

When does back pain count as chronic?

Duration decides, not the number of bad days. NICE guideline NG59, last updated in July 2026, uses two terms. Acute means less than three months. Chronic means three months or longer, and NICE adds that the intensity of pain may fluctuate over time.

The German national guideline splits it into acute (under six weeks), subacute (six to twelve weeks) and chronic (more than twelve weeks). Its 2017 edition is no longer valid and is being revised. Neither guideline sets a minimum number of pain days per month.

Research uses a stricter rule. An NIH task force counts low back pain as chronic after at least three months, with pain on at least half the days of the past six months. The task force says this is a research standard, not one for general clinical use. Whether your pain counts as chronic is for your doctor to say. Sam does not classify your pain.

What should you write down between appointments?

The NHS Fife pain management service gives its patients a simple daily diary. You mark your pain from 0 (no pain) to 10 (worst pain) and note what you were doing at the time. You record any pain medicine when you take it. A line at the bottom covers sleep and how you felt that day. For back pain, a few details make such a diary far more useful:

  • The date, on good days too. A blank day later reads as pain-free or forgotten, and nobody can tell which.
  • Pain on one scale that you always use the same way, such as 0 to 10.
  • Where it hurts and where it spreads: one side, into the buttock, down the leg, past the knee.
  • When it is better or worse: morning, evening, at night, sitting, lying down, walking.
  • Morning stiffness in minutes, and whether moving around eases it.
  • What you could not do: putting on socks, sitting through a meeting, carrying the shopping.
  • What you tried or took, and whether things got better, worse or stayed the same.
  • A word on sleep, stress and mood.
  • New symptoms such as numbness, tingling or weakness in a leg. These belong with a doctor, not only in the diary (see the section on symptoms that need a doctor now).

An invented example, not a benchmark: "Wed, lower back left, into the buttock, 5/10 after two hours sitting, stiff 20 minutes on waking, slept badly".

Morning stiffness has its own reason to be on the list. The NHS describes the back pain of ankylosing spondylitis, one cause of inflammatory back pain. It gets better with exercise but not with rest, and it is worse in the morning and at night. Symptoms tend to develop gradually. So write down the minutes, not just "stiff", and raise the pattern with your doctor.

Ask the practice beforehand which period they want to see. Whether paper or an app suits you better is covered in symptom diary: paper template or app.

What will your GP or physio ask?

NICE asks clinicians to consider other causes whenever they review someone with low back pain, especially if symptoms are new or have changed. Examples are cancer, infection, injury or inflammatory disease such as spondyloarthritis. That is why a new or changed symptom is worth writing down with its date.

For each new episode, NICE suggests a risk tool such as the STarT Back questionnaire at the first contact. That contact can be a GP or a physiotherapist. The tool has nine short questions. They cover pain spreading down the leg, pain elsewhere, how much the pain limits what you do, how bothersome the pain has been, and thoughts and feelings such as fear, worry, gloomy thoughts and low mood. NICE then suggests lighter support for people likely to improve quickly and more intensive support for those at higher risk.

The German national patient guideline (2017 edition, no longer valid) lists typical questions:

  • Where is the pain, and does it spread?
  • When did it start, and have you had back pain before?
  • Have you noticed weakness or changed feeling in your legs?
  • Do you have trouble passing urine or opening your bowels?
  • When is the pain better or worse, during the day or at night?
  • Has it changed over the last days, weeks or months?
  • How bad is it, and does it limit everyday tasks?
  • What has been tried so far?
  • Are you under stress, anxious or often tense?

The stress question is not small talk. The same guideline counts stress, low mood and anxiety among the circumstances that can help back pain persist. To prepare the rest of the visit, use the doctor appointment checklist for a chronic condition. Which clinician to see for which problem is covered in what doctor to see for back pain.

Why isn't a scan usually the first step?

When the history and examination show no sign of a serious cause, NICE says not to routinely offer imaging in a non-specialist setting. In specialist settings, such as a hospital clinic, imaging should be considered only if the result is likely to change management.

Scans find a lot that does not explain the pain. Germany's Institute for Quality and Efficiency in Health Care (IQWiG) cites MRI studies in adults. About 20 percent of people aged 20 to 40 and over 80 percent of people over 70 have a bulging disc, yet no back pain. If limiting pain lasts four to six weeks despite care, the German guideline has the doctor check whether imaging is needed. A scan should not be repeated unless the symptoms change markedly. If the pain gets worse or new symptoms appear, contact your practice earlier.

It is different when there are signs of a serious cause, such as those in the section on symptoms that need a doctor now. Then your doctor arranges further tests, such as an X-ray, an MRI or blood tests, as urgently as needed. If you already have a normal MRI result, back pain but a normal MRI explains what that means.

Should you rest or stay active?

NICE recommends that advice for people with low back pain includes encouragement to continue with normal activities. The NHS says to stay active and try to continue with your daily activities, and not to stay in bed for long periods.

Which kind of movement suits you, and how much, is something to settle with your GP or physiotherapist. Sam gives no exercises for your back, and the general movement tips in the app know nothing about your back. In your diary, note what you did and how your back felt afterwards.

Which back pain symptoms need a doctor now?

Some symptoms still need the emergency department or a doctor straight away, and others need a doctor's check, even though back pain rarely has a serious cause. The groups follow the NHS back pain page, IQWiG and the German patient information.

Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US) or go to an emergency department if back pain comes with any of these:

  • Pain, tingling, weakness or numbness in both legs.
  • Numbness in your buttocks or around your genitals or anus.
  • Changes in your bladder or bowels, such as difficulty peeing, or losing control of your bladder or bowels.
  • Changes in how your penis or vagina feels during sex, not being able to get or keep an erection, or not being able to orgasm.
  • Chest pain.
  • Pain that started after a serious accident, such as a car accident.

Do not drive yourself. Ask someone to drive you or call an ambulance.

Get medical help straight away, without waiting for your next appointment, for any of these. In the UK that means an urgent GP appointment or NHS 111. Elsewhere, ask for a same-day appointment or your local out-of-hours service.

  • Signs of paralysis, severe symptoms, new numbness or growing weakness in one leg.
  • A fever, chills, night sweats, or feeling hot, cold, shivery or generally unwell.
  • Severe pain that starts suddenly or gets worse quickly.

See a GP or your doctor about any of these:

  • Weight loss without trying, loss of appetite or a general feeling of physical weakness.
  • A history of cancer.
  • Severe pain at night or at rest.
  • Pain that gets worse at night or when you lie on your back, or that does not ease with rest.
  • Pain after a fall or, with osteoporosis, after heavy lifting or an awkward twist of the spine.
  • Pain spreading down a leg, especially past the knee or into the foot, also with numbness, tingling or weakness.
  • Several signs of inflammatory back pain together: pain lasting more than twelve weeks, a gradual start, morning stiffness that eases with movement and gets worse with rest.
  • Back pain together with psoriasis, inflammatory bowel disease, joint or tendon inflammation or inflammation of the middle layer of the eye.
  • A lump or swelling in your back, or your back has changed shape.
  • Pain that is worse when sneezing, coughing or pooing.
  • Pain between the shoulder blades rather than in the lower back.
  • Back pain that does not improve after a few weeks at home, stops your day-to-day activities, or leaves you worried or struggling to cope.

With the first two groups, do not wait for it to pass. A diary entry does not replace that check. Sam gives no medical assessment of your entries, including numbness or tingling.

What does Sam keep, and what stays on paper?

Sam's symptom diary offers Lower back pain, Body aches, Neck pain or stiffness, Morning stiffness, Numbness or tingling and Muscle cramps, among others. Each symptom gets one entry per day: mild, moderate or severe. For body aches, numbness or tingling and muscle cramps you can tap a body region, such as the back or the left thigh. The regions are coarse. There is no time of day, no note and no 0-to-10 scale.

Steps and exercise minutes from Apple Health are in the same app as a trend, a few taps from your entries. In the statistics and the monthly report, Sam does not calculate a relationship between them and your entries. As-needed medicines from your medication list can be ticked off on today's symptom sheet under "Took something?". There is no reminder for them. Sam gives no dosing advice.

You create the monthly report for the previous month yourself. The PDF shows your symptom days on a calendar, your five most logged symptoms, and pages on activity, sleep and stress. It needs notifications allowed, Apple Health access and an answer to the chronic-condition question. From the second report on, you also need to have logged how you felt on at least 15 of the last 30 days: good, a bit off or sick. Symptom entries do not count toward that. The report has no medication list. Its activity page prints general movement tips that know nothing about your back.

Paper keeps what the symptom diary cannot: the 0-to-10 scale, times of day, where the pain spreads, stiffness minutes and what helped. What any app can and cannot do for a long-term condition is covered in what a health app can and cannot do. What else Sam shows for this condition is on the chronic low back pain page.

Log your back pain days in Sam and bring the monthly report

You arrive with counted symptom days instead of an impression, with no tallying the night before.

  • Instead of a notebook left at home: you log lower back pain, morning stiffness or numbness or tingling on your phone, per day, as mild, moderate or severe.
  • Instead of a second app for steps: steps and exercise minutes from Apple Health are in the same app as a trend.
  • Instead of a tally sheet: you create the monthly report yourself; the PDF shows your symptom days on a calendar and your five most logged symptoms.

The symptom diary keeps no 0-to-10 scale, times of day or notes, so paper stays useful for those. The report has requirements, listed above. More on the chronic low back pain page.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Sources

Updated: October 2026

More on Chronic Low Back Pain

Frequently Asked Questions

When is back pain considered chronic?+

NICE, the UK guideline body, counts low back pain as chronic once it has lasted three months or longer, and notes that the intensity may fluctuate over time. Anything shorter is acute. The German national guideline (2017 edition, no longer valid) uses more than twelve weeks. Neither sets a minimum number of pain days per month. Whether yours counts is for your doctor to say.

Does back pain that comes and goes count as chronic?+

It can. NICE says the intensity of chronic pain may fluctuate, so it does not have to be bad every day. For research, an NIH task force uses a stricter definition: pain for at least three months, on at least half the days of the past six months. The task force says that definition is for studies, not for general clinical use.

What should I write in a back pain diary?+

For each day: the date, good days included, your pain on a fixed 0 to 10 scale, where it hurts and where it spreads, when it is better or worse, and how many minutes you are stiff in the morning. Add what you could not do, what you tried or took and whether anything changed afterwards, plus a word on sleep, stress and mood.

What will a GP or physio ask about chronic back pain?+

Expect questions on where it hurts and whether it spreads, when it started, when it is better or worse, how it has changed, how much it limits you and what you have tried. You will also be asked about weakness or numbness in your legs, bladder or bowel problems, and stress or anxiety. At the first contact for a new episode, NICE suggests a short risk questionnaire such as the STarT Back tool.

Do I need an MRI for chronic low back pain?+

Not routinely. When there is no sign of a serious cause, NICE says not to routinely offer imaging in a non-specialist setting, and to consider it in specialist care only if the result is likely to change management. MRI scans show disc changes in many people who have no back pain at all. If there are signs of a serious cause, your doctor arranges further tests according to how urgent they are.

Which back pain symptoms need medical help, and how fast?+

Call your local emergency number or go to an emergency department for pain, tingling, weakness or numbness in both legs, numbness in the buttocks or around the genitals or anus, difficulty peeing or loss of bladder or bowel control, changes in how your penis or vagina feels during sex, erection problems or not being able to orgasm, chest pain, or pain after a serious accident. Get medical help straight away, without waiting for your next appointment (in the UK, an urgent GP appointment or NHS 111; elsewhere, a same-day or urgent appointment with your doctor or your local out-of-hours service), for signs of paralysis, severe symptoms, new numbness or growing weakness in one leg, a fever, chills, night sweats or feeling generally unwell, or severe pain that starts suddenly or gets worse quickly. See a doctor about weight loss without trying, loss of appetite or a general feeling of physical weakness, a history of cancer, severe pain at night or at rest, pain that gets worse at night or when you lie on your back or does not ease with rest, pain after a fall or, with osteoporosis, after heavy lifting or an awkward twist of the spine, pain spreading down a leg, especially past the knee or into the foot, also with numbness, tingling or weakness, several signs of inflammatory back pain together (pain lasting more than twelve weeks, a gradual start, morning stiffness that eases with movement and gets worse with rest), back pain together with psoriasis, inflammatory bowel disease, joint or tendon inflammation or inflammation of the middle layer of the eye, a lump, swelling or change of shape in your back, pain that is worse when sneezing, coughing or pooing, pain between the shoulder blades, and back pain that does not improve after a few weeks at home, stops your day-to-day activities, or leaves you worried or struggling to cope.

Can I keep a back pain diary in Sam?+

Partly. In Sam's symptom diary you log lower back pain, morning stiffness or numbness or tingling per day as mild, moderate or severe, and for body aches you can tap the back as the body region. There is no 0 to 10 scale, no time of day and no note, so those stay on paper.

Related Articles

October 25, 2026

Back Pain but a Normal MRI: What It Means, What to Log

October 25, 2026

What Doctor to See for Back Pain That Won't Go Away

October 24, 2026

Osteoarthritis Pain Diary: What to Write Down