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Back pain - modern management
Back pain is very common. Most people will have one or more bouts of back pain at some point in their life. Most bouts resolve within a few weeks, and serious or permanent damage is rare
UNDERSTANDING THE BACK
Your spine is one of the strongest parts of your body. It is made up of solid bony blocks (called vertebrae) joined by discs of strong rubber-like tissue which allows the spine to be flexible .It is reinforced by strong ligaments, and surrounded by large and powerful muscles that protect it
Most cases of back pain that develop suddenly are due to ‘simple back pain’ rather than any serious disease. Most back pain comes from the working parts of your back - the muscles, ligaments & small joints. Your back is simply not moving and working as it should. You can think of it ‘being out of condition’. What you do about back pain yourself is usually more important than the exact diagnosis or treatment
WHAT ARE THE TREATMENTS FOR SIMPLE BACK PAIN?
What you do in the early stages is very important. Rest for more than a day or two usually does NOT help and may actually prolong pain and disability. Your back is designed for movement: it needs movement - a lot of movement. The sooner you get moving and doing your ordinary activities as normally as possible, the sooner you will feel better. The people who cope best with back pain are those who stay active and get on with life despite the pain
Even when your back is painful, you can make a start without putting too much stress on it:
- Walking
- Swimming
- Exercise bike
- Dancing/yoga/keep fit
- In fact most everyday activities and hobbies - don't stop doing things, just change the way you do them
- Either stay at work or return to work as soon as possible
Try to avoid staying in one position for too long – particularly sitting and standing. You may need to adjust your chair/desk and computer, and take regular breaks. You should also look at our advice on Computer Ergonomics, as poor posture when using computers is a common source of back and neck pain
Anxiety and stress can increase the amount of pain we feel. Tension can cause muscle spasm and the muscles themselves can become painful. Many people feel anxious about back pain – but remember that serious damage is rare and that the long-term outlook is good .Do not let fear and worry hold back your recovery
PAIN RELIEF
Regular pain killers may be needed initially to help control the pain and let you get started
- Paracetamol is often effective if taken regularly – for an adult this is usually 1000mg ( two 500mg tablets) taken four times a day
- Ibuprofen ( anti-inflammatory painkillers) can be taken in addition to Paracetamol if necessary, usually in a dose of 400mg taken three times a day. Some people with asthma, stomach ulcers, high blood pressure, kidney failure or heart failure may not be able to take anti-inflammatory painkillers
- Stronger painkillers such as Codeine are an option if anti-inflammatories do not suit you. Codeine can be taken in addition to Paracetamol. Codeine may cause constipation which can aggravate back pain if you need to strain to go to the toilet – have plenty of water & fruit in your diet to prevent this
All these pain killers are available from a pharmacy without a prescription
WHEN DO I NEED TO SEE A DOCTOR?
Most people manage to deal with simple back pain themselves by following the advice in this leaflet. However if you have severe pain that gets worse over several weeks instead of better, or if you are unwell with back pain you should see your doctor
Your doctor will normally be able to diagnose simple back pain from the description of the pain, and by examining you. In most cases no tests are needed. X-rays or scans of the back are not usually helpful in simple back pain
Here are a few symptoms, which are all very rare, but if you do have back pain and suddenly develop any of these you should see a doctor straight away:
- Difficulty passing or controlling urine
- Numbness around your anus or genitals
- Numbness, pins and needles, or weakness in both legs
- Unsteadiness on your feet
GETTING ON WITH YOUR LIFE
People who cope with the pain by being positive, staying active and getting on with life tend to get better faster and have fewer problems in the long run. Regular exercise and staying fit helps your general health and your back
Source: Adapted from The Back Book - A reliable source of information for people suffering from low back pain [Roland et al, 2002]. It is written by a team consisting of a GP, orthopaedic surgeon, physiotherapist, osteopath, and psychologist and provides comprehensive advice