Lower back pain advice

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Lower back pain is a very common medical complaint. In the UK, 60-80% of people are affected at some time in their lives. Each year, 120 million working days are lost due to back pain. Lower back pain can affect anyone at any age. If pain lasts for less than three months, it is called acute back pain. If the problem goes on for longer, it is known as chronic back pain.

Understanding the Back

The spine is made up of a column of small bones called vertebrae, which are separated by discs which allow the spine to bend. Strong ligaments attach to the vertebrae, which give extra support and strength to the spine. Various muscles also surround and are attached to the spine. The spinal cord threads through the centre of each vertebra, carrying nerves from the brain to the rest of the body.

Types of Lower Back Pain:
Simple ‘mechanical’ back pain
This is the most common type, affecting about 19 in 20 cases of acute (sudden onset) back pain. The cause of most cases is thought to be a sprain or small tear to a ligament or muscle. Usually nothing abnormal shows up in tests such as X-rays, and generally nothing in the back is permanently damaged. The pain can range from mild to severe. The pain is typically located in one area of the lower back and may also spread to the buttocks and thighs.

Simple back pain triggers include:
• Poor posture
• Lack of exercise
• Standing or bending down for prolonged periods
• Sitting in a chair that doesn’t provide enough back support
• Sleeping on a mattress that doesn’t provide enough back support
• Lifting, carrying or pulling loads that are simply too heavy, or going about these tasks in the wrong way

Most acute simple back pain eases within a week or so. In 9 out of 10 cases, the symptoms have gone or greatly eased within six weeks. However, once the pain has gone, it is common to have further bouts of pain in the future. In a small number of cases, symptoms persist for several months – this is chronic back pain. The back is a strong and robust part of the body designed to perform physical work. Being active is generally good for the back. Exercise is helpful in speeding recovery from simple back pain.

Nerve Root Pain
Neve root pain is the cause of lower back pain in less than 5% of people. The pain is due to a nerve being irritated or pressed on as it leaves the spinal cord. This results in pain along the course of the nerve, therefore you will feel pain down the leg to the calf or foot (sometimes called ‘sciatica’). Often this pain is worse than pain in the back. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of the buttock or leg.

When to see a doctor
In a relatively small number of cases (less than 1 in 100), back pain may have a more serious underlying cause. This includes abnormality of the spine, an infection or collapse of the vertebrae, fibromyalgia (a condition that affects muscles), tuberculosis, or cancer. Most cases of lower back pain last only a few days and improve on their own. As a general guide, back pain with any of the following symptoms may indicate that the cause is not simple back pain and may be a more serious problem. You should see a doctor if they occur:

• fever
• redness or swelling on the back
• numbness or weakness in one or both legs
• loss of bladder and bowel control
• pain that develops gradually, and slowly gets worse, especially if you have other conditions such as cancer, HIV, or you take steroids
• pain lasting more than a few days in someone under 20 or over 55 years old

Do I need any tests?
In most cases, the doctor will only need to discuss the symptoms and carry out an examination. X-rays or scans of the back are not helpful for most people with back pain. More tests may be recommended by your doctor if an underlying cause is suspected. Psychological wellbeing can also play a part in back pain. If the condition is chronic, the doctor may also recommend psychological and social assessment.

Treatments for simple lower back pain
Stay Active
Research has shown that it is better to continue with normal activities as much as possible, however as a rule, don’t do anything which causes a lot of pain. If pain is so bad that taking to bed seems the only option, keep bed rest as short as possible. Sleep in the most naturally comfortable position.

If you need painkillers, it is better to take them regularly, as it may prevent the pain from getting severe, and enable you to exercise and keep active. Please take medications according to the manufacturer’s instructions.
• Paracetamol or Ibuprofen are usually enough to relieve simple back pain.
• Codeine is an option if anti-inflammatory medicines do not suit or work well. Constipation is a common side-effect of codeine which may make back pain worse if you need to strain to go to the toilet. To prevent constipation, have lots to drink and eat foods with plenty of fibre.
• A muscle relaxant such as diazepam is occasionally prescribed for a few days if the back muscles become very tense and make the pain worse. Diazepam is one of a group of medicines called
benzodiazepines which can be habit-forming and should be taken for as short a period of time as possible.

Osteopathy and chiropractics are treatments involving manipulation of the spine. They may provide short-term relief for simple pain within the first six weeks. Back exercises and physiotherapy may be helpful if the pain lasts longer. Please discuss this with your GP first.

Complementary Approaches
The Alexander Technique may help improve posture. Acupuncture is helpful in some individuals, although evidence for its effectiveness is debatable. Please discuss this with your GP first.

Specialist Referral
If chronic back pain is unrelieved by other treatments, your GP may decide to refer you to an Orthopaedic Surgeon.

Managing Back Pain
• Regular exercise – the aim is to get the supporting back muscles supple and strong.
• Posture – avoid standing or walking in a bent-forward position. Sleep on a firm mattress.
• Lifting – lift only a manageable weight and do not bend your back when you lift. Bend at the knees and keep your back straight.
• Lose weight – if you are overweight, it puts extra stress on the back.
• Be back aware – many bouts of back pain may not be due to heavy work but as a result of bad posture or bad lifting techniques.

If you have any further queries, please contact:
• Backcare (national back pain association): www.backcare.org.uk
• Emergency Department: 01908 995 913 ext. 2409 between 9am and 10 pm
• Hospital switchboard: 01908 660033 between 10pm and 9am
• Call NHS 111
• Your GP surgery