A pain in the back

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Lower back pain is something that commonly occurs in adults. Almost everyone gets back pain at some point, and it can be quite frustrating to deal with, so it is important to educate yourself on it in case it happens to you.

 

How worried should I be about lower back pain?

Most cases of lower back pain go away by themselves. However, if you have any of the following symptoms, or are concerned, you should seek advice from your doctor:

If you have had a recent fall or injury to your back

• Have numbness or weakness in your legs
• Have trouble with bladder or bowel control
• Have unexplained weight loss
• Have a fever or feel unwell 
• Take a steroid medication such as prednisolone on a regular basis 
• Have diabetes or a medical problem that weakens your immune system 

 

Have a history of cancer or osteoporosis

You should also seek medical advice if:

• Your pain is so severe that you cannot perform simple tasks
• Your back pain does not start to improve within 3-4 weeks

 

What about chronic (longer-term) low back pain)?

Back pain can persist for a long time, and can have ‘serious’ effects even when it is not ‘dangerous’. It is important to see your doctor for assessment if you have not done so previously, or if there is a change in your back pain.

 

Parts of the back:

The back is made up of:

• Vetebrae: a stack of bones sitting on top of one another with a hole in the centre of each bone, which forms a hollow tube that protects the spinal cord when stacked.
• Discs: these are rubbery discs that sit between each of the vertebrae to add cushion and allow movement
• Spinal cord and nerves: the spinal cord is a ‘highway’ of nerves that connects the brain to the rest of the body. It runs through the hollow passage created by the vertebrae and nerves branch out from this at multiple levels, connecting to the arms, legs and organs. This is why back pain can affect other areas of the body.
• Muscles, tendons and ligaments: together, these are known as the soft tissue of the back, and help to hold the back together.

 

What can cause back pain?

In many cases, the cause of back pain is hard to determine. Back pain can arise from straining a muscle or ligament (soft tissue), and if this is the case, there is no way to know for sure.

Back pain can also result from:

• Damaged, bulging or torn disc
• Arthritis of the joints of the spine
• Bony growths of the vertebrae that can crowd or compress nearby nerves
• A vertebrae out of place
• Narrowing of the spinal canal
• A tumour or infection (rare)

 

Do I need an investigation, like and x-ray or MRI?

Most episodes of back pain do not need imaging and will resolve within 4-6 weeks. Your doctor will assess your symptoms and examine you to determine whether you need further testing.

 

What can I do to improve my back pain?

After being assessed by a doctor, the best thing you can do is to stay as active as possible, even if you are in pain. It is known that people with lower back pain recover faster if they stay active. It is important to walk as much as you can, and return to normal exercise as soon as you can. It is also important to remember to not overdo it, and if you are worried about your exercise routine or your back pain to discuss this with your doctor.

When you start to feel better, your doctor can refer you onto a physiotherapist, or give you exercises to strengthen your back and make it less likely to have back pain in the future.

Other treatments are available, and a very small proportion of people require surgery. Other options include:

• Medications: many over the counter medications such as NSAIDs (ibruprofen, nurofen) combined with paracetamol can be beneficial in improving pain to allow exercise. If these non-prescription medications do not work, your doctor may be able to prescribe stronger medications.
• Physical therapy for special exercises and stretches
• Injections of medications to reduce swelling

 

References

1. Crowley K, Martin KA 2017, Patient education: Low back pain in adults (The Basics)
2. HealthDirect 2017, Back Pain, HealthDirect
3. Ingraham P 2017, When to Worry About Low Back Pain, PainScience.com