Back Pain

Back pain is a very common problem;  4 out of 5 people will have significant back pain at some time in their lives. Fortunately, most cases are not serious, require little in the way of treatment, and gradually get better over time. In most cases the exact cause of the pain is not clear, but it will not be due to a serious disease or serious back problem.. This is called nonspecific lower back pain. The usual advice for nonspecific lower pack pain is to keep active, and do normal activities as much as possible. Painkillers can help until the pain eases. In some cases chronic (persistent) pain develops and further treatment may then be needed.

What are the usual causes of back pain?

The most common type of back pain is simple backache, where the pain is usually in the lower back and occasionally spreads to the thighs or buttocks. It is caused most often by a sprain or minor tear to a ligament or muscle in the back, usually from awkward or heavy lifting, twisting or bad posture (such as sitting at an incorrectly designed work station or desk. The severity of the pain can vary from mild to severe.

A smaller number of cases of back pain are caused by a nerve being trapped as it comes out from the spinal cord;  this can be due to a slipped disc, a bad muscle tear or other problems such as arthritis. This type of nerve root pain is often called sciatica and pain is felt along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot, and the pain in the leg or foot is often worse than the pain in the back. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. In cases where sciatica is caused by a slipped, or prolapsed disc in the back, part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc and the prolapsed part of the disc can press on a nerve nearby and cause the pain.

What are the symptoms of back pain?

Sometimes a pain may develop immediately after you lift something heavy, or after an awkward twisting movement, and sometimes it can develop for no apparent reason. Some people just wake up one day with low back pain which can range from mild to severe. The pain is sometimes worsened by coughing, sneezing or moving. If a nerve is trapped there may be pins and needles or numbness down one leg..  Symptoms that should be assessed by a doctor include weakness of the legs, problems with the bowels or bladder, weight loss or back pain that develops gradually.

Are tests needed for back pain?

No, not usually. Your doctor will usually be able to diagnose nonspecific low back pain from the description of the pain, and by examining you, and in most cases no tests are needed. There is no test that can prove or confirm nonspecific low back pain. Occasionally, tests such as X-rays, scans or blood tests may be advised if there are symptoms, or signs during a doctor’s examination, to suggest that there may be a serious underlying cause for the back pain. Symptoms that may trigger tests include:

       
  • Pain that develops gradually and gets worse and worse over days or weeks
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  • Constant back pain, not eased by lying down or resting
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  • Pain that travels to the chest
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  • Weakness of any muscles in a leg or foot
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  • Lack of feeling (numbness) in any part of your bottom or leg
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  • If you have taken steroid tablets for more than a few months

How is back pain treated?

Most cases of back pain ease within a few weeks.  With a sudden ‘acute’ episode of back pain, avoid prolonged bed rest as this may make it worse -  it is much better to keep active. Regular treatment with painkillers or anti-inflammatory tablets will allow movement and exercise to continue. Occasionally muscle relaxants are prescribed if there is a lot of muscle spasm in the back, and some people find that manipulation of the back by an osteopath or chiropractor speeds up their recovery. Treatment will vary from person to person, and the situation should be reviewed by a doctor if the pain becomes worse, or if the pain persists beyond 4-6 weeks, or if symptoms change.

How to prevent back pain

To prevent future back pain, exercise regularly (swimming is a good choice), lose weight and avoid standing, sitting or walking with a stooped posture. Avoid bending the back when lifting, and sleep on a firm mattress.

Once the pain has eased or gone it is common to have further bouts of pain (recurrences) from time to time. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain, and  it is quite common for further episodes to occur in the future. In a small number of cases the pain persists for several months or longer. This is called chronic back pain, and should be reviewed by a doctor.