Back pain - back pain usually affects the lower back. It can be a short-term problem,
lasting a few days or weeks, or continue for many months or even years. Most
people will have some form of back pain at some stage in their lives.
About back pain. Back pain is extremely common - about four in five
people are affected at some point in their lifetime. Anyone can get back pain at
any age, but it's most common in people between the ages of 35 and 55, or over.
Your back has many interconnecting structures, including bones, joints,
muscles, ligaments and tendons. Its main support structure is the spine, which
is made up of 24 separate bones called vertebrae, plus the bones of the sacrum
and coccyx. Between the vertebrae are discs that act as shock absorbers and
allow your spine to bend. Your spinal cord threads down through the central
canal of each vertebra, carrying nerves from your brain to the rest of your
It's often very difficult to know exactly what causes back pain, but it's
usually thought to be related to a strain in one of the interconnecting
structures in your back, rather than a nerve problem. Back pain caused by a more
serious, underlying condition is rare and you're unlikely to be affected unless
you are very old or very young.
What are the symptoms of back pain? If you have low back pain,
you may have tension, soreness or stiffness in your lower back area. This pain
is often referred to as 'non-specific' back pain and usually improves on its own
within a few days.
Back pain may be called either 'acute' or 'chronic' depending on how long
your symptoms last. You may have:
acute back pain - lasting less than six weeks
sub-acute back pain - lasting six weeks to three months
chronic back pain - lasting longer than three months
You should see your GP as soon as possible if, as well as back pain, you have:
a fever (high temperature)
redness or swelling on your back
pain down your legs and below your knees
numbness or weakness in one or both legs or around your buttocks
loss of bladder or bowel control (incontinence)
constant pain, particularly at night
pain that is getting much worse and is spreading up your spine
These symptoms are known as red flags. It's important to seek medical help for
these symptoms to ensure you don't have a more serious, underlying cause for
your back pain.
What are the causes of back pain? For most people with back
pain, there isn't any specific, underlying problem or condition that can be
identified as the cause of the pain. However, there are a number of factors that
can increase your risk of developing back pain, or aggravate it once you have
it. These include:
standing, sitting or bending down for long periods
lifting, carrying, pushing or pulling loads that are too heavy, or going about
these tasks in the wrong way
having a trip or a fall
being stressed or anxious
having poor posture
There may be other, more serious underlying causes of your low back pain, but
these are rare. They include:
fracture - a crack or break in one of the bones in your back
osteoporosis - a condition where bones lose density causing them to become weak,
brittle and more likely to break
a slipped disc - this is when a disc bulges so far out that it puts pressure on
your spinal nerves
spinal stenosis - a condition in which the spaces in your spine narrow
spondylolisthesis - when one of your back bones slips forward and out of
degenerative disc disease - when the discs in your spinal cord gradually become
osteoarthritis - a wear-and-tear disease that can particularly affect the joints
of your spine
rheumatoid arthritis - an inflammatory condition in which your immune system
causes inflammation of the lining of your joints and surrounding structures
Low back pain may also be caused by an infection or cancer, but these two causes
are very rare.
Diagnosis of back pain - your GP will usually be able to diagnose low
back pain from your symptoms and there will be no need for further tests. If,
however, your symptoms don't improve after a few weeks, or you have some red
flag symptoms, he or she may refer you to a back clinic to have:
a CT scan (a test that uses X-ray equipment and computer software to create
pictures of the inside of your body)
an MRI scan (a test that uses magnets and radiowaves to produce images of the
inside of the body)
These tests are used to find out if you have a more specific, underlying cause
for your back pain.
What are the treatments for back pain? If your back pain is
non-specific, your GP will recommend you try self-help measures. Alternatively,
he or she may prescribe medicines or refer you for physical therapy if your pain
is severe or chronic. If, however, your GP suspects you have a specific
underlying cause, he or she may refer you to a back clinic or a pain clinic to
see if you are suitable to have spinal injections. These are used to find out
the exact source of, and also to treat, your back pain but aren't suitable for
Self-help for back pain - there are a number of things you can do to
help relieve low back pain.
Stay active and continue your daily activities as normally as you can. Bed rest
may actually make low back pain worse, so try to limit the time you spend
resting to a minimum.
Apply hot or cold packs to the affected area. You can buy specially designed hot
and cold packs from most pharmacies. If you prefer, you can apply a cold
compress, such as ice or a bag of frozen peas, wrapped in a towel. Don't apply
ice directly to your skin as it can damage your skin.
Medicines for back pain - taking an over-the-counter painkiller (such as
aspirin or paracetamol) or anti-inflammatory medicine (such as ibuprofen) is
often enough to relieve acute low back pain. You can also use creams, lotions
and gels that contain painkillers or anti-inflammatory ingredients. Always read
the patient information that comes with your medicine and if you have any
questions, ask your pharmacist for advice.
If your pain is severe or chronic, your GP may prescribe stronger medicines such
as diazepam, morphine or tramadol. However, these aren't suitable for everyone
because they can be addictive and cause side-effects. Always ask your doctor for
advice and read the patient information leaflet that comes with your medicine.
Physical therapies for back pain - a physiotherapist (a health
professional who specialises in maintaining and improving movement and mobility)
may be able to help you design a programme to help you exercise and stretch.
Alternatively, your GP may refer you for physical therapy such as physiotherapy,
chiropractic treatment or osteopathy (therapies that are given alongside
conventional treatments) to help with your back pain. Treatment can involve
exercises, posture advice, massage, and techniques known as spinal mobilisation
and spinal manipulation. Treatment courses usually last about six to 12 weeks.
Surgery for back pain - back pain, even if it's chronic, can usually
be treated or managed successfully, but about one in 10 people have ongoing
problems. Back surgery is really only considered as a last resort if the pain is
related to a specific cause.
Some people find acupuncture can help relieve low back pain. You may be able to
have a course of up to 10 sessions over a 12-week period.
Also, you could try a pain-management programme to help you deal better with and manage your symptoms.
You should always talk to your GP before trying any complementary therapy.
Prevention of back pain - good back care can greatly reduce your risk
of getting low back pain. To look after your back, make sure you:
take regular exercise - walking and swimming are particularly beneficial
try to keep your stress levels to a minimum
bend from your knees and hips, not your back
maintain good posture - keep your shoulders back and don't slouch.
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