A one-piece back support apparatus comprises a belt portion being configured to provide back and abdominal support encircling a wearer's waist and a compression pants portion. The belt portion has a front portion, a back portion, a top portion, a bottom portion and an inner surface. The compression pants portion secured to the belt is configured to provide support for the wearer's pelvis, legs, and groin area. The inner surface of the belt has one or more pack support portions with slots for receiving one or more gel packs so as to maintain contact between the gel packs and the wearer's back. Slots in the belt portion may accommodate vertically extending inserts of rigid plastic to reinforce the belt portion over the lumbar region of the wearer.