Back pain: A common sense approach

Caspar Aylott Spinal Consultant, Cheltenham Hospital More by this author
Spine surgeon Caspar Aylott offers his common sense solutions for a common problem.

Around 85 percent of us will suffer from back pain at some stage in our lives, impacting our lifestyles and our mental wellbeing. As the most common cause for time off work, it can also have a huge effect on employees' livelihood and employers' bottom line.

Most episodes of low back pain are resolved within six weeks, but recurrent episodes are typical and up to 20 percent of 20 to 60-year-olds will experience persistent or chronic back pain (lasting more than 12 months). The risk of back pain increases as we get older, and plateaus by the age of 65.

How to take action against back pain

1. Keep on moving
Generally speaking, if you have back pain you should try and keep the back moving, ideally with some gentle back stretches. If the pain is very severe then sometimes one or two initial days of rest may be necessary, but ideally not longer.

2. Go over-the-counter
Painkillers, particularly regular paracetamol, and an anti-inflammatory, such as ibuprofen, taken at maximum recommended dose and continuously (if tolerated by the stomach) is the most effective. Codeine-based analgesia can also be added, and all of these medications are available over the counter without prescription, under the supervision of the pharmacist who can advise further.

3. Consider physiotherapy
If the pain is not settling within a week then it may be worth seeing a physiotherapist who can provide specific stretches and exercises, along with targeted massage and gentle manipulation. Very forceful cracking or manipulation is best avoided.

4. Don't let it linger

If the back pain is not significantly improving within four to six weeks, with a maximum of four to six treatments, then the therapist should discuss referring you to a specialist, such as a spinal surgeon. You should not be having multiple repeated treatments or doubling up on treatments forevermore.

Most people never need surgery, but having the most in-depth knowledge and understanding of the back means that spinal surgeons are best placed to diagnose your back problems accurately and only a specialist is qualified to interpret what further investigations, such as MRI scans may reveal.

Reaching a diagnosis will help to exclude more serious spinal problems and ensure that you're receiving the most specific and effective treatment. 

Feeling the pinch?

Back pain can arise from different parts of the spine, such as the intervertebral discs, which are the cushions or shock absorbers between the bones, or from the small joints (facets) behind the spine. Sometimes the spinal canal can become narrow as we age, and this can lead to pinching of nerves. This can result in back pain, but more typically sciatic symptoms in the legs, which might include pain, pins and needles or numbness. It's important to recognise that when nerves are pinched this can result in weakness or loss of limb function, affecting standing or walking, but it is often entirely treatable once diagnosed.

Typical treatments for back pain include:

  • Specific exercises to strengthen the core, such as pilates or yoga
  • Appropriate lifestyle changes or pacing of activities 
  • Targeted injections.

Used selectively for the right type of problem, surgery can also be very successful with 90 percent improvements recorded, low complication rates, short or day case hospital stays, rapid mobilisation and return to work.

When should you worry about back pain?

Thankfully, most cases of back pain are not serious or life threatening, but certain symptoms may raise concerns that there is a more serious underlying problem (so called ‘red flags’). 

These might include:

  • Unremitting night pain
  • First presentation of pain after the age of 55
  • Weakness in the legs or loss of control of the bladder or bowels, or 
  • Being unwell with sweats or loss of weight.

If these symptoms do present themselves, this should prompt urgent review by a specialist.

Wednesday 6 February 2019