BACK PAIN

Back pain is really common. It affects about 80% of adults at some point of their life.

Back pain is the most common cause of disability and sick days from work. It affects men and women, young or old. It can be mild or debilitating. It can start suddenly or slowly. You can feel it in a small area of your back or over a wide area of your back. It can last days or years. It can sometimes be hard to treat.

Back pain is often short term or acute, and lasts a few days to a few weeks. It usually improves on its own with self-care. It is called subacute back pain if it lasts between 4 and 12 weeks.

Chronic back pain on the other hand, lasts for 12 weeks or longer, even after the initial injury or underlying cause of pain has been treated. Chronic back pain can occur in about 20% of people that get acute back pain. This means that in 20% of people your pain can continue for much longer than expected and in some of those cases the chronic lower back pain can be difficult to treat.

BACK PAIN SYMPTOMS

Sometimes back pain can occur suddenly or it can occur slowly. Back pain can also occur immediately after an injury or the onset of symptoms can be delayed.

Symptoms may include; a sharp pain, or a stiff back, pain radiating down into the buttock or leg and even into the foot. There might be tingling, numbness, pins and needles and weakness.

Sometimes people can be very unwell if there is a more serious cause like an infection or fracture of the spine.

• Back Strains and strains of muscles, ligaments, and tendons.

• Sometimes back muscle pain can be related to myofascial pain syndrome which causes muscle spasms and tenderness. The psoas muscle or any other muscle in your lower back could be in spasm, causing you pain.

• Back joints

  • The joints in the back are called facet joints. The facet joints can become inflamed and swollen (arthropathy), which can cause stiffness and pain. Sometimes facet joint pain can be debilitating and long-lasting.

• Muscles around the back are complex and can be a source of pain. These muscles can become weak or go into spasms.

• Myofascial pain

  • This is pain that occurs because of problems with the surrounding muscles, ligaments and tendons of the back. The muscles may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) surrounding muscle and can be very painful and quite debilitating. When a trigger point is touched or examined, it can cause exquisite pain in and around the area.

• Lumbar spondylosis (osteoarthritis) is back arthritis

  • An age-related condition that affects the joints, discs and ligaments of the back. This can also occur in the sacroiliac joint.

• Spondylolisthesis

  • Pronounced spon-di-low-list-thee-sis.

  • Misalignment of spine bones occurs when one vertebra slips over the one below it. It can be caused by problems with the bone or disc degeneration or ligament issues. It usually occurs with spondylosis. Another type of misalignment is when there is a curved spine (scoliosis).

• Degenerative disc disease

  • When lumbar discs degenerate and change, they can sometimes become painful.

• Referred pain

  • Referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the spine and brain. Back problems like facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerves). This compression condition is called lumbar foraminal stenosis and can cause radiating pain anywhere down into the buttock, leg or foot.

• Nerve pain

  • Sometimes neurological problems can cause back pain. Neurological causes might include shingles (zoster), post herpetic neuralgia, or even some spine conditions like meningitis. When a compression occurs into the spinal column itself, this may be called lumbar spinal stenosis and if the compression is serious it can compress the spinal cord itself, which is called myelopathy. Myelopathy is when the compression of the spinal cord starts causing symptoms, such as weakness or problems with coordination in the arms, hands, legs, or even feet.

• Sensitisation

  • Sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain seems to be spreading up into the body and or down into the arm, or even into the other side of the body. People with sensitisation can even have sensitive skin in the back region and even light touch using a brush can be exquisitely painful.

• Post-surgical pain

  • After an operation or surgery pain can sometimes persist even after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes the persistent back pain can be intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, and can be caused by many things, including nerve injury or scarring, ongoing inflammation or infection, muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons. This is called post-laminectomy syndrome or also called Failed Back Surgery Syndrome (FBSS)

Contact us to find out what's causing your pain.

WHO GETS BACK PAIN?

Anyone can get back pain and it can occur at any age, with the majority of first incidents taking place between 20-40 years of age. 

Some people are more likely to develop back pain. Here are a few risk factors that might make the development of back pain more likely:

• Older age

• Lack of exercise and low fitness level

• Being overweight

• Certain jobs or activities that require heavy lifting, pushing or pulling, particularly when it involves twisting or vibrating the spine. An inactive job like a desk job may also contribute to pain especially with a poor posture or a chair without adequate back support.

WHAT BACK PAIN TREATMENT IS AVAILABLE? 

Treatment of the back pain depends on if the problem is acute (meaning it only occurred recently i.e. days and weeks) or if the problem is chronic (meaning it has been present for more than 2-3 months).

ACUTE BACK PAIN TREATMENT

• Simple treatments like hot or cold packs, physical activity and exercise and physical therapy.

• Pain medications like anti-inflammatories and anti-spasm medications to provide you pain relief.

If pain is long lasting (chronic pain), debilitating and has not been responding to treatments an assessment should be made by a pain management specialist, who can assess and treat most types of chronic pain.

TYPES OF TREATMENT

• Medications to reduce to pain

• These may be simple over the counter medications or can be pain medications prescribed by your pain specialist. Medications might include muscle relaxants or nerve pain medications (neuropathic pain medications). Sometimes analgesic compound creams are used to ease pain.

• Pain interventions

  • Injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain.

  • It includes interventional therapies like nerve blocks (medial branch nerve, lumbar nerve roots, cluneal nerves, gluteal nerves, sciatic nerve, lumbar plexus), radiofrequency ablation (RFA), pulsed radiofrequency (PRF) and epidural and nerve root injections. Sympathetic nerve blocks can also be performed. Some of these therapies can be focused on various structures that might be causing or making the pain worse like the lumbar facet joints, the spinal nerve roots and other nerves around the back. Platelet-rich plasma can also be used in some locations around this area.

• Nerve stimulation or neuromodulation techniques

  • Advanced pain reduction strategies may include spinal cord stimulation for severe back pain. Some forms of spinal cord stimulation are high frequency stimulation (HF10), tonic stimulation, multi-waveform stimulation, BurstDR stimulation and even Dorsal Root Ganglion (DRG) stimulation.

• Surgery

  • Generally recommended when tests show structural changes, which need corrective surgery. When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. These are typically performed by a neurosurgeon or a spinal surgeon. Types of surgery might include, decompression surgery (laminotomy, laminectomy, discectomy) and or stabilisation surgery (fusion)

• Rehabilitation

  • Most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.

WARNING SIGNS OF MORE SERIOUS BACK PROBLEMS

In some instances, pain can indicate more serious back problems. These problems might include cancer, fractures, infection, severe nerve compression (pinched nerve) and ankylosis spondylitis. 

• If there is cancer in the bones of the spine, this usually means metastases (the cancer has spread to the spine).

• Fractures of the spine can be caused by a direct hit, fall, accident but sometimes can occur without trauma, called spontaneous fractures. Spontaneous fractures, usually can occur in elderly people with osteoporosis or those who may be taking medications that weaken the bone.

• Infections of the spine tend to occur if patients have a weakened immune system from any cause or medical condition. Sometimes infections of the spine can occur if there is an infection elsewhere in the body. People with spinal infections usually feel unwell and can have sweats and a fever.

• Nerve compression, called myelopathy, where there is a dangerous compression of the spinal cord in the neck. Myelopathy could cause symptoms that might include, weakness or problems with coordination in the legs or feet.

• Ankylosing spondylitis is progressive arthritis of the spine and can cause widespread inflammation, pain and stiffness throughout the spine, including back pain.

Seek urgent and specialist medical advice if you have:

• Sudden, unrelenting, disabling and severe back pain

• Recent weight loss

• Recent injury or fall

• Signs of infection are present like fever or feeling unwell, the area is red, hot or swollen

• Numbness or tingling of the arm

• Weakness in arms and or legs

• Problems with bladder or bowel function

• Stiffness is worsening

• Pain does not settle by itself after a few days or weeks