Most back pain is related to either poor posture or recent heavy work and usually settles with minor pain killers such as Paracetamol within a few days. However sometimes it lasts longer and may be due to one of the following causes:

1) Pain from a slipped (prolapsed) disc

This is caused by part of the disc between the vertebrae of the spine bulging out of its capsule. See diagram

The pain is felt intially in the back then may travel down the leg to usually below the knee. Pins and needles and occasionally areas of numbness may occur. Sometimes there may be weakness of the muscles leading to an inability to stand on tip toe on one leg. It usually hurts to cough and sneeze. This is a condition that in most people will settle on its own, however if the pain is severe or there is significant weakness you may be referred to a neurosurgeon who will confirm the diagnosis using a scanner and then remove the part of the disc that is bulging out by using the operating microscope. This is an effective and reasonably safe procedure.

If the pain is not as bad as this it may settle with simple rest. However it is not worth resting more than forty eight hours.

Other possible treatments include manipulation and epidural injections. Manipulation is offered by osteopaths, chiropractors and orthopaedic physicians and some physiotherapists. It is on the whole a safe procedure, providing the practitioner is competent.

Epidurals are given by doctors, either orthopaedic physicians or anaesthetists. It involves giving an injection of local anaesthetic and usually a small dose of steroid into the epidural space. The injection is placed just above the tail bone and results in the inflamed area where the disc is bulging being bathed in the anti-inflammatory steroid. In most cases this is not a painful procedure but may need to be repeated up to about three times before it is effective.

However most people find the pain will settle using simple analgesics such as Paracetamol or Co-Codamol available over the counter. If this is not sufficient your doctor can prescribe stronger medication.

WARNING SIGNS

• Sudden loss of control of your bladder or bowels
• Loss of sensation in the "saddle area" where you would sit on a saddle!
• Pain and pins and needles in both legs

See your GP as soon as possible

2) Mechanical Back Pain

Pain arising from the ligaments and from the joint itself. This tends to be recurrent and does not travel down below the knee. It is most common between the ages of 20 and 50 and then tends to get better. It is characterised by bouts of pain often precipitated by an awkward movement. It is best treated in the initial stages by simple pain killers such as Paracetamol or Co-Codamol. Ibuprofen which is an anti-inflammatory medicine can help, but may cause bleeding or indigestion and in susceptible patients may precipitate asthma.

Exercise tends to help this sort of back trouble particularly swimming or walking. You may find exercise uncomfortable to start with but you can be reassured that you will not be causing any damage.

Manipulation by a registered chiropractor or osteopath or physiotherapist can be helpful, you can also be referred to an orthopaedic physician, a qualified doctor with a special interest in the non surgical treatment of back and joint disorders.

Operation is not a good idea in this sort of back pain. X-rays are also unlikely to be helpful.

If you get recurrent back pain at the same level, you may be recommended to have sclerosant injections. These are given to try and tighten up the ligaments around the back to help prevent recurrence. They have been in use since the early 1950’s and can be very helpful.

Physiotherapists run classes called back schools to help people learn how best to cope and manage back pain.

In severe cases where other treatments have not helped you may be referred to a pain clinic where all sorts of treatment including drugs, injections, use of a TENS machine, acupuncture and psychological treatments can be offered.

WARNING SIGNS that may indicate manipulation will not be helpful:

• Pain that is getting steadily worse despite treatment
• Pain that travels below the knee or into both legs
• Disturbances of urination or bowel function
• Sensory disturbances
• Treatment with anticoagulants
• History of cancer
• Recent severe injury

3) Other Causes Arising from the Back

Osteoporosis

Pain from softening of the bones, more common in women and tends to occur after the menopause, HRT can help prevent this as can a diet high in Calcium and regular exercise to a level of breathlessness. It can also occur in elderly men. The diagnosis is usually confirmed with a bone density scan and there is specific treatment available from your own GP.

 

Arthritis

Osteoarthritis and rheumatoid arthritis and gout can all cause episodes of back pain and can be treated with analgesics and anti inflammatory medication

 

Infection

In the past TB caused back pain but there are infections that can cause osteomyelitis however you will usually feel very unwell with this.

 

Pagets Disease of the Bones

A condition caused by abnormal blood flow through the bones, leading to pain and swelling of the bones. Fortunately this is quite rare.

4) Pain arising from Structures outside the Back

Caused often by serious conditions such as cancer of the prostate in men and breast in women. Kidney disease such as stones can also cause back pain. This will give rise to urinary problems such as pain or bleeding when you pass urine.

WARNING SIGNS

• Pain occuring for the first time over 60 yrs
• Pain getting progressively worse
• Pain and feeling unwell

Dr David Anderson

Orthopaedic Physician