Back Pains, Midback pains & Neck pains


 
 
                                                             

                         

         

Back pains, Upper back pains and Low Back pain (also known " lumbago") is pain felt in the lower back that usually originates from the muscles, nerves, bones, joints or other structures in the spine besides referred pain from abdominal organs.

The pain can often be divided into  upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. Pain may radiate in the upper back, or in the low back, (and might radiate into the leg or foot), and may include symptoms other than pain, such as weakness, numbness or tingling.

Back pain is one of humanity's most frequent complaints. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.

Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues.

What are the Symptoms ?
 
Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

 

          

 

   
     

   

 What Is the treatment?

· Most back pains can be treated with exercises and without surgery.

· Treatment involves using pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation. 

· The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury. 

· Medications, Gentle Oil massages, Pain gels are often helpful for short time in acute and chronic low back pain. 

· Cold and hot compresses  resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals. 

· Bed rest is recommended for only if pain aggravating with activities.  Individuals should resume activities as soon as possible. 


· Exercise are the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. 

· In the most serious cases, when the condition does not respond by above methods, further investigations such as Xrays, MRI scan and blood tests are adviced.

   

Treatment



Treatment may include avoiding further stress on the back by modifying physical activities, painkillers, physiotherapy.

Bed rest, 
Epidural steroid injections and target injections injections or surgery is recommended, in severe cases.


Surgery may relieve pain caused by back problems if all methods fail and there is definite serious neurological deficit.



The best way to treat back pain is to keep moving........fear stops people. 'Being active will make back pain better'

This fear is understandable - it can be very painful - but it is essential to stay on the go.

There is no place for total bed rest in back pain. 

Gradually increase the amount of activity you do, and try to avoid long periods of inactivity.


'However, back pain shouldn't cause you to stop doing exercise or the regular activities you enjoy.

Exercise is now accepted as the best way to treat back pain and this includes weight-training, where appropriate.


http://www.bbc.com/news/health-37305032


MYTH - 'A scan will show me exactly what is wrong' ..........In some cases, a scan will be necessary.


Here's how......Even people without back pain can see changes to their spine on a scan or X-ray.

But if you see changes in a scan, you may become fearful of exercising and doing the other activities.


Woman holding back


'Pain does not equals damage'

There may be physical reasons but there may also psychological or even social factors at play, and it's important to identify and address those.

The key again, as with all of these myths, is to overcome the fear factor to avoid a person's condition worsening.

Of course, I should point out that this advice is general in nature, will not apply to everyone and anyone who experiences back pain that lasts longer than six weeks is advised to see a physiotherapist or doctor.

But if we can begin to knock down these myths, we can start to make inroads on a condition that affects millions of us every day.

  


  

General measures to help treat osteoarthritis/spondylitis

Exercise

If possible, exercise regularly. 

This helps to strengthen the muscles around affected joints, to keep you fit, and to maintain a good range joint movement. 

Speed walking for 1 hour, cycling and Swimming are good for most joints, but any exercise is better than none. 

Many people can manage a regular walk.

Weight control is mainly by diet control and balanced diet of salads and fruits with cooked food.


Avocado

If you are overweight, try to lose some weight as the extra burden placed on back, hips, and knees can make symptoms worse. Even a modest weight loss can make quite a difference.

  • Wearing a Lubar belt or knee brace.

These measures slightly alter the distribution of weight and pressure on the knee joint, which is why they are thought to ease symptoms in some cases. A podiatrist or physiotherapist can advise exactly how to use them.

Braces or supports may also be helpful for other joints affected by OA. For example, a support around the thumb for painful thumb OA.

Daily walking for 30 to 45 minutes with or without Walking aids

If you have OA of your hip or knee, when walking try using a cane (walking stick). Hold it in the hand on the opposite side of the body to the affected joint. This takes some pressure off the affected joint and helps to ease symptoms in some cases.


Diet - Vitamins, minerals, calcium should be obtained from natural dietary resources and 

not by 'vitamin tablets/capsules' which can increase your risk of 'medicinal side-effects'. 

Fruits, Salads, green vegetables/leaves, Sprouts -250 grammes

Curd/Yoghurt -250 grammes, 

Lemon juice with little salt/sugar.

Water -5-6 lit per day or more, daily slow sustained yoga type physiotherapy exercises as given in website is essential for good health of bones and body.

  



Daily brisk/speed walking for 1 hour, getting enough vitamin D from your diet, sunlight will decrease your risk.

Cycling outdoors and non-gym outdoor exercises such as brisk walking, using stairs at home and office, walk at work bring overall improvement in health, well being besides controlling and curing many diseases such as Hypertension, diabetes, depression, cancer, osteoporosis, arthritis, muscular pains and joint pains. 

Physical activity. Not exercising and being inactive or staying in bed for long periods can increase your risk.

Smoking. Smokers harm their blood circulation, damage all tissues in body by free radicals of smoke and absorb less calcium from their diets.

Medications. Some commonly used medicines can cause loss of bone mass. These include steroids used to control arthritis and asthma; some drugs used to treat seizures; some cancer drugs; and, too much thyroid hormone.

Low body weight. Women who are very thin – and small-boned – are at greater risk for osteoporosis.

Physiotherapy help if unable to follow correct exercises

Sometimes advice or treatment from a physiotherapist is helpful. For example:

  • For advice on which exercises to do to strengthen the muscles above the knee (quadriceps) if you have OA of the knee. Strengthening the 'quads' has been shown to improve symptoms caused by OA of the knee.
  • For advice on how to keep active and fit.
  • For advice on shoes insoles, knee braces, taping to the knee, and how to use walking aids properly (to make sure you have one of the correct height).

Manipulation and stretching around affected joints may be helpful. This is something that physiotherapists may also be able to help with.

Occupational therapy

An occupational therapist may be able to help if you need aids or modifications to your home to cope with any disability caused by OA. Special devices, such as tap turners to help with turning on a tap, may mean that you can carry out tasks around the house more easily.

Other therapies

  • Some people have found that TENS (Transcutaneous Electrical Nerve Stimulator) machines help to ease pain from OA. A TENS machine delivers small electrical pulses to the body via electrodes placed on the skin.
  • Acupuncture may also help to ease symptoms in some cases.
  • Some people find that they can also get some pain relief from using hot or cold packs on the affected joint(s). This is also called thermotherapy. You can use a hot water bottle filled with either hot or cold water and apply it to the affected area. Or, special hot and cold packs that can either be cooled in the freezer, or heated in a microwave, are also available.

Medicines used to treat osteoarthritis

Paracetamol

Paracetamol is the common medicine used to treat OA. It often works well to ease pain. It is best to take it regularly to keep pain away, rather than 'now and again' when pain flares up. A normal adult dose is two 500 mg tablets, four times a day. It usually has little in the way of side-effects, and you can take paracetamol long-term without it losing its effect.

Anti-inflammatory painkillers

You may find that a topical preparation of an anti-inflammatory painkiller that you rub onto the skin over affected joints is helpful instead of, or in addition to, paracetamol tablets. This may be particularly helpful if you have knee or hand OA. Compared to anti-inflammatory tablets, the amount of the drug that gets into the bloodstream is much less with topical preparations, and there is less risk of side-effects (see below).

Anti-inflammatory painkillers that are taken by mouth are not used as often as paracetamol. This is because there is a risk of serious side-effects, particularly in older people who take them regularly. However, one of these medicines is an option if paracetamol or topical anti-inflammatories do not help. Some people take an anti-inflammatory painkiller for short spells, perhaps for a week or two when symptoms flare up. They then return to paracetamol or topical anti-inflammatories when symptoms are not too bad. There are many different brands of anti-inflammatory painkillers. If one does not suit, another may be fine.

Side-effects may occur in some people who take anti-inflammatory painkillers:

  • Bleeding from the stomach is the most serious possible side-effect. This is more of a risk if you are over 65, or have had a duodenal or stomach ulcer, or if you are also taking low-dose aspirin. Stop the medicine and see a doctor urgently if you develop indigestion, upper abdominal pain, or if you vomit or pass blood. Read the leaflet that comes with the medicine for a list of other possible side-effects. You doctor can prescribe another medicine that can help to protect your stomach if you are taking anti-inflammatory painkillers in the long-term. You should discuss this with them.
  • Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to take anti-inflammatory painkillers.

Codeine

Codeine is sometimes combined with paracetamol for added pain relief. Constipation is a common side-effect from codeine. To help prevent constipation, have lots to drink and eat a high fibre diet.

Capsaicin cream

This cream is made from chilli peppers and it works by blocking the nerve signals that send pain messages to the brain. It may be helpful if you have knee or hand OA. It takes a while for the effects of this cream to build up and may take around one month to get the maximum benefit. You should rub in a pea-sized amount of cream around the affected joint four times a day, and not more often than every four hours.

Don't use this cream on broken or inflamed skin. You may notice some burning after you apply the cream but this tends to improve the longer you have used it. Avoid having a hot bath or shower, before, or after, applying the cream because it may make the burning sensation worse. Also, be careful to wash your hands after applying the cream. Because it is made from chilli peppers, it can cause burning if it gets into your eyes, mouth or around your genital area.

An injection of antiinflammatory medicine

An injection directly into a joint is useful if a joint becomes badly painful / inflamed.


   

Treatments that are not normally recommended

Glucosamine, cartilage regenerative drugs are Usually not helpful in long term as no reliable studies on them. besides they may affect liver function and kidneys.

Hyaluronic acid

The use of regular injections of hyaluronic acid directly into a joint is a relatively new treatment that has been tried for OA. The theory is that it may help with 'lubrication' and 'shock absorption' in a damaged joint. It may produce a small beneficial effect in some people. However, the National Institute for Health and Clinical Excellence (NICE) has looked at the use of hyaluronic acid as a possible treatment for OA and does not recommend its use. This is because there is little evidence that it is effective.

Chondroitin

This is another food supplement that has become popular as a potential treatment for OA. It is a chemical that is part of the make-up of normal cartilage. A recent big study showed that chondroitin has little, or minimal, effect on reducing symptoms in people with OA. Also, NICE does not recommend the use of chondroitin for the treatment of OA. This is because they could find no clear evidence from studies to show that it is an effective treatment.

Surgery for osteoarthritis/spondylitis

Most people with OA/spondylitis do not have it badly enough to need surgery. However, OA of a joint may become severe in some cases. Some joints can be replaced with artificial joints. Hip and knee replacement surgery has become a standard treatment for severe OA of these joints. Some other joints can also be replaced.What is the prognosis?

  •  Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is no reduction in    pain  and inflammation after 72 hours of self-care. 
  •  Recurring back pain resulting from improper body mechanics or other non-traumatic causes is often preventable.
  •  Engaging in exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries.
  •  Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture.
  •  Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.



The fast way to losing weight?





Intermittent fasting, often referred to as IF, is an increasingly popular eating plan that involves significantly restricting your food intake on certain days, while eating normally on others 

Huge claims have been made for IF around enhanced weight loss, including improved mental functioning, a reduced risk of disease and even a longer life.

So how does it work?

There are a number of ways to approach IF depending on how often you decide to fast each week and how much you eat on fasting days.

One of the most popular IF regimes is the 5:2 plan, where each week is made up of five days eating normally (preferably healthily) and two days fasting. The latter are not technically fasting days, as you're allowed to consume 600 calories on each day if you're a male and 500 calories if you're a female. The final rule is that the two fasting days should not be consecutive.

Some practical tips and considerations

You're obviously going to feel some degree of hunger and even some lack of energy on the fasting days, so you should carefully consider how this will affect your life.

Fasting on days when you're busy can be a good idea so that you don't have too much time to think about eating. Exercising on a fasting day however is not advisable, as your energy levels will be lower and you're likely to feel even hungrier for the rest of the day.

Stay hydrated on fasting days with plenty of water and fruit or herbal teas - this will prevent dehydration and help you to feel more full, as well as have a mild detoxifying effect.

And finally, if you have any medical conditions whatsoever that may be affected by changes to your diet, then you should talk to your doctor GP first before starting.

 

Non-specific Back Pain in Adults

About 9 in 10 people have one or more bouts of low back pain. In most cases, it is not due to a serious disease or serious back problem, and the exact cause of the pain is not clear. This is called non-specific lower back pain. The usual advice is to keep active, and do normal activities as much as possible. Painkillers can help until the pain eases. In most cases, the pain clears within a week or so but may recur from time to time. Chronic (persistent) pain develops in some cases, and further treatment may then be needed.

Understanding the lower back

The lower back is also called the 'lumbosacral area' of the back. It is the part of the back between the bottom of the ribs and the top of the legs.

Most of the lower back is made up from muscles that attach to, and surround, the spine. The spine is made up of many bones called vertebrae. The vertebrae are roughly circular and between each vertebra is a 'disc'. The discs between the vertebrae are a combination of a strong fibrous outer layer and a softer, gel like centre. The discs act as shock absorbers and allow the spine to be flexible.

Strong ligaments also attach to adjacent vertebrae to give extra support and strength to the spine. The various muscles that are attached to the spine enable the spine to bend and move in various ways.

The spinal cord, which contains the nerve pathways to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae to take and receive messages to various parts of the body.

What are the types of back pains and low back pain?

Non-specific low back pain

This is the most common type of back pain. About 19 in 20 cases of acute (sudden onset) low back pain are classed as 'non-specific'. This is the type of back pain that most people will have at some point in their life. It is called 'non-specific' because it is usually not clear what is actually causing the pain. In other words, there is no specific problem or disease that can be identified as to the cause of the pain. The severity of the pain can vary from mild to severe. This type of back pain is discussed further below.

Nerve root pain - often called 'sciatica'

This occurs in less than 1 in 20 cases of acute low back pain. Nerve root pain means that a nerve coming out from the spinal cord (the 'root' of the nerve) is irritated or pressed on. (Many people call this a 'trapped nerve'.) You feel pain along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot. 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.

About 9 in 10 cases of nerve root back pain are due to a prolapsed disc - often called a 'slipped disc'. (A disc does not actually 'slip'. What happens is that part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc. The prolapsed part of the disc can press on a nerve nearby. See separate leaflet called 'Sciatica and Prolapsed Disc' for details.) Other less common conditions can cause pressure on a nerve to cause nerve root pain.

Cauda equina syndrome - rare, but an emergency

Cauda equina syndrome is a particularly serious type of nerve root problem. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the 'saddle' area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. See a doctor immediately if you suspect cauda equina syndrome.

Less common causes of low back pain

Arthritis (inflammation of the joints) of the spine sometimes causes back pain. Osteoarthritis is the common form or arthritis and usually occurs in older people. Ankylosing spondylitis is another form of arthritis that can occur in young adults and causes pain and stiffness in the lower back. Rheumatoid arthritis may affect the spine, but you are likely to have other joints affected too. There are separate leaflets on each of these types of arthritis.

Various uncommon bone disorders, tumours, infections, and pressure from structures near to the spine occasionally cause low back pain. (Less than 1 in 100 cases of low back pain.)

The rest of this leaflet is mainly about non-specific low back pain - the common type of low back pain.

What is the cause of non-specific back pain?

Non-specific low back pain means that the pain is not due to any specific or underlying disease that can be found. It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small 'facet' joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain.

To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is non-specific back pain which means there is no serious problem or disease of the back or spine.

What are the symptoms of non-specific back pain?

Sometimes a pain may develop immediately after you lift something heavy, or after an awkward twisting movement. Sometimes it can develop for no apparent reason. Some people just wake up one day with low back pain.

Although non-specific back pain is sometimes called 'simple' back pain, simple does not mean that the pain is mild. The severity of the pain can range from mild to severe. Typically, the pain is in one area of the lower back, but sometimes it spreads to one or both buttocks or thighs. The pain is usually eased by lying down flat. It is often made worse if you move your back, cough, or sneeze. So, non-specific low back pain is 'mechanical' in the sense that it varies with posture or activity.

Most people with a bout of non-specific low back pain improve quickly, usually within a week or so, sometimes a bit longer. However, once the pain has eased or gone it is common to have further bouts of pain (recurrences) from time to time in the future. Also, it is common to have minor pains 'on and off' for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain (discussed in more detail later).

How is non-specific back pain diagnosed?

Most people who develop back pain that comes on suddenly (acutely) have non-specific back pain. If there are no other associated symptoms and the pain is not too bad, many people are confident to just 'get on with it' and treat it themselves - and indeed most get better quickly. However, if in doubt, see your doctor for a check-over and advice.

A doctor will usually want to ask questions about your symptoms, and examine you. Basically, the symptoms are usually as described above, with no other worrying symptoms to suggest anything serious or another cause of back pain (such as the ones listed below). The examination by a doctor will not detect anything to suggest a more serious cause of back pain. Therefore, a doctor can usually be confident from his or her assessment that you have non-specific back pain.

As a general guide, if any of the following occur then it may not be non-specific low back pain, and there may be a more serious underlying cause. But note: the vast majority of people with low back pain do not have any of the following symptoms or features. They are included here for completeness, and as an aid to 'what to look out for' and to tell your doctor should they occur.

  • Pain that develops gradually, and slowly gets worse and worse over days or weeks.
  • Constant back pain that is not eased by lying down or resting.
  • Pain that travels to the chest, or is higher in the back behind the chest.
  • Weakness of any muscles in a leg or foot.
  • Numbness (lack of feeling) in any part of your bottom or leg.
  • If you have taken steroid tablets for more than a few months.
  • Symptoms that may indicate an inflammatory (arthritis) cause such as ankylosing spondylitis. The main ones are:
    • Pain which is worse in the second half of the night or after waking.
    • Stiffness, in addition to pain, of the back muscles in the morning after getting up from bed that lasts more than 30 minutes.
    • The pain is eased (and not made worse) by activity.
  • Symptoms that may indicate cauda equina syndrome. The main ones are, in addition to back pain:
    • Numbness around the anus (the 'saddle' area).
    • Bladder symptoms such as loss of bladder sensation; loss of bladder control, incontinence, loss of sensation when passing urine.
    • Incontinence of faeces.
  • Symptoms that may indicate a fracture in the spine The main ones are:
    • Back pain following major trauma such as a road accident or fall from a height.
    • Back pain following minor trauma in people with osteoporosis.
  • Symptoms that may indicate infection or spread of cancer affecting the spine. The main ones are:
    • Onset of pain in a person over 50 years, or under 20 years, of age.
    • Pain that remains when lying down; aching night-time pain disturbing sleep.
    • Symptoms or problems in addition to pain such as:
      • If you have or have had a cancer of any part of the body.
      • General symptoms, such as fever, unexplained weight loss, etc.
      • If you inject street drugs.
      • If you have a poor immune system. For example, if you are on chemotherapy or have HIV/AIDS.

Do I need any tests?

Usually not. Your doctor will usually be able to diagnose non-specific low back pain from the description of the pain, and by examining you. Therefore, in most cases, no tests are needed. There is no test that can prove or confirm non-specific low back pain. In fact, some doctors argue that tests can actually do more harm than good when the diagnosis is non-specific low back pain. For example, the technical jargon used to report on some scans can sometimes sound alarming, when in fact the scan is just showing what would be normal for a given age and not a cause for pain.

Current UK guidelines are clear that routine tests such as X-rays and scans should not be done if the diagnosis is made of non-specific back pain.

Tests such as X-rays or scans may be advised in certain situations. This is mainly if there are symptoms, or signs during a doctors examination, to suggest that there may be a serious underlying cause for the back pain.

What are the treatments for a bout of non-specific back pain?

The following advice and treatment is commonly given for a sudden 'acute' bout of non-specific low back pain.

Exercise and keep going

Continue with normal activities as much as possible. This may not be possible at first if the pain is very bad. However, move around as soon as you are able, and get back into normal activities as soon as you can. As a rule, don't do anything that causes a lot of pain. However, you will have to accept some discomfort when you are trying to keep active. Setting a new goal each day may be a good idea. For example, walking around the house on one day, a walk to the shops the next, etc.

Also, sleep in the most naturally comfortable position on whatever is the most comfortable surface. Advice given in the past used to be to sleep on a firm mattress. However, there is no evidence to say that a firm mattress is better than any other type of mattress for people with low back pain. Some people find that a small firm pillow between the knees when sleeping on the side helps to ease symptoms at night.

If you have a job, aim to get back to work as soon as possible. There is no need to wait for complete freedom from pain before returning to work. Returning to work often helps to relieve pain by getting back to a normal pattern of activity and providing a distraction from the pain.

In the past, advice had been to rest until the pain eases. It is now known that this was wrong. The evidence from research trials is that you are likely to recover more quickly by getting moving again, and getting back to work as soon as possible. Also, you are less likely to develop chronic (persistent) back pain if you keep active when you have back pain rather than rest a lot.

Medication

If you need painkillers, it is best to take them regularly. This is better than taking them 'now and again' just when the pain is very bad. If you take them regularly the pain is more likely to be eased for much of the time and enable you to exercise and keep active.

  • Paracetamol is often sufficient if you take it regularly at full strength. For an adult, this is 1000 mg (usually two 500 mg tablets), four times a day.
  • Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people may not be able to take anti-inflammatories. For example, some people with asthma, high blood pressure, kidney failure, or heart failure.
  • A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. This 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.

Other treatments

Heat such as a hot bath may help to ease pain.

Treatment may vary, 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. Other pain relieving techniques may be tried if the pain becomes chronic (persistent).

What is the outlook (prognosis)

Most of us (about 8 in 10 people) will have a bout of non-specific low back pain at some point in our life. The severity can vary. However, it is difficult to quote exact figures as to outlook. This is partly because it is so common and many people with back pain do not consult a doctor. Roughly, it is thought that:

  • Most non-specific back pains ease and go quickly, usually within a week or so.
  • In about 7 in 10 cases, the pain has either gone or has greatly eased within four weeks.
  • In about 9 in 10 cases the pain has gone or has greatly eased within six weeks.

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

Chronic (persistent) non-specific back pain

Non-specific back pain is classed as chronic (persistent) if it lasts longer than six weeks. In some people it lasts for months, or even years. Symptoms may be constant. However, the more usual pattern is where symptoms follow an irregular course. That is, reasonably long periods of mild or moderate pain may be interrupted by bouts of more severe pain.

What is the treatment for chronic non-specific back pain

Initial treatment is similar to 'acute' attacks. That is, aim to keep as active as possible. Also, painkillers can help. In addition to the painkillers listed above, your doctor may advise a course of an antidepressant medicine in the 'tricyclic' group, for example, amitriptyline. Tricyclic antidepressants have other actions separate to their action on depression. They are used in a variety of painful conditions, including back pain.

Also, a national guideline (from NICE - referenced below) recommends one or more of the following treatments should be considered. Each of these treatments has some evidence from research trials to suggest that they will help to ease symptoms in some people (but not all):

  • Structured exercise programme. This means a programme of exercise supervised by a professional such as a physiotherapist. This is likely to be in a group setting. Exercises may include aerobic activity, movement instruction, muscle strengthening, posture control and stretching. It typically consists of up to eight supervised sessions over 8-12 weeks with encouragement to keep on doing the exercises at home between sessions.
  • Manual therapy. Typically this includes several sessions of massage, spinal mobilisation and/or spinal manipulation. With spinal mobilisation the therapist moves the joints of the spine around in their normal movement range. In spinal manipulation, the therapist moves joints beyond the usual range of movement.
  • A course of acupuncture treatment. It is not clear how this may work. (Some doctors feel that this is a controversial recommendation as the evidence for effectiveness is weak.)

Cognitive behaviour therapy (CBT) may also be recommended as a treatment option. There is good evidence from research trials that it can help. CBT aims to help you to change the way that you think, feel and behave. It is used as a treatment for various health problems including various types of chronic pain.

If the above treatments have not helped much then you may be referred to a specialist pain clinic. Rarely, a surgical operation called spinal fusion is considered when all other treatment options have not helped and pain remains constant and severe.

Can further bouts of back pain be prevented?

Evidence suggests that the best way to prevent bouts of low back pain is simply to keep active, and to exercise regularly. This means general fitness exercise such as walking, running, swimming, etc. There is no firm evidence to say that any particular 'back strengthening' exercises are more useful to prevent back pain than simply keeping fit and active. It is also sensible to be 'back aware'. For example, do not lift objects when you are in an awkward twisting posture.

Further information and advice

Backcare (The National Back Pain Association)

16 Elmtree Road, Teddington, Middlesex, TW11 8ST
Tel: 0845 130 2704 Web: www.backcare.org.uk

The Back Book

A reliable source of information. It is written by a team consisting of a GP, orthopaedic surgeon, physiotherapist, osteopath, and psychologist and provides comprehensive advice. Roland, M.O et al. (2002) The back book. London: The Stationary Office.

References



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