Got a bad back?

Written by Colin Brennan, medical journalist



It can happen walking up a hill, lifting a suitcase, watching TV or even while lying in bed. There is a feeling of something going 'click' in the lower part of the spine. There doesn't have to be a passing-out stab of pain or lingering feeling of any kind but the person knows exactly what's happened. They've ricked their back again. It may seem like just a little sprain at first but over the next 24 hours it is likely to slowly disable its unfortunate victim.

What does it feel like?

First there will be a lack of flexibility in the back, then some pain on walking or bending with gradual stiffness spreading throughout the body. Eventually, virtually every movement is painful. Lying down may give some relief but it can be so bad that even turning over in bed has to be planned ahead.

Getting out of bed may involve rolling on to the floor and agonisingly raising yourself to a crawling position before slowly being able to tease the body to its feet. Even then, only holding yourself with total rigidity is bearable. Walking becomes more crab-like than human.

Worst of all, the afflicted person knows full well, or if it is their first attack they are about to find out, this could last up to six weeks and is likely to happen again within a year.

Who gets back pain?

If you suffer from back pain, it may be of some small comfort to know that you are far from being alone. A recent survey commissioned by the Department of Health found that 40 per cent of adults in Britain had suffered from back pain in the previous 12 months while 15 per cent of back pain sufferers were in pain all year. A conservative estimate is that 11 million working days are lost each year as a result of back pain.

Young people tend to get acute attacks of back pain that can resolve themselves quickly. With older people the pain is more likely to be chronic.

It strikes men and women equally but some people are more at risk because of their jobs. Generally back pain is more common in skilled manual workers, partly skilled and unskilled workers. You are at higher risk if you drive more than 25,000 miles a year and surprisingly train drivers have a greater incidence of lower back pain than the drivers of heavy goods vehicles. People who work intensively on the telephone for more than two hours a day without a headset and supermarket cashiers are also likely to be hit by back pain.

How do you know it is back pain?

Dr Jeremy Sager, a GP in Leeds who revised 'The Which? Guide to Managing Back Pain,' published in January 2001, said: 'First, it is very important to make sure that your problem is back pain and not something more serious.'

The pain should be:

in the lower back.

not involve the legs.

it should begin suddenly and not have come on insidiously.

be related to movement and be present all the time.

the individual should feel well apart from the back pain.

there should not be a sudden loss of weight.

The problem can be confused with sciatica which is caused by the degeneration of an intervertebral disc and typically results in back pain accompanied by pain shooting down the legs. This may need further investigation and a visit to the GP is recommended according to Dr Sager. The pain from sciatica can be severe.

Although it is very rare, tumours can occur in the spine or lungs and present as back pain. This is also true for kidney problems as well as pelvic and abdominal diseases. If there is any doubt, the GP should be asked for an opinion.

What causes back pain?

Dr Loic Burn, medical advisor to BackCare, the National Organisation For Healthy Backs (Formerly known as the National Back Pain Association), said: 'There is no known single cause for back pain, which makes it difficult to name a specific treatment or method of prevention. Heavy lifting, for instance, can be a cause of back pain but it is in a minority of cases. Basically we don't know what causes it,' he said.

What can be done for back pain?

Until quite recently, doctors used to advise complete bed rest for backache victims. Rightly or wrongly, it became firmly linked in the public's mind with the work shy. Now it is all change. The more active you can remain, the better.

Dr Loic Burn said the new international guidelines for the treatment of back pain are based on evidence that clearly shows that the more active you can be with back pain the sooner you recover.

'The best medical advice is to take painkillers at once at the full dosage.'

Dr Sager agrees and puts it even more strongly. 'You should take paracetamol or ibuprofen at the maximum dose. There is no use in pussyfooting about or indulging in self-martyrdom. You have to really attack the pain, which can be quite bad. Being as active as you can and taking the painkillers cannot possibly do you any harm and you will be back to living a normal life more quickly,' he said.

Evidence also shows that manipulation does work for back pain specially if it is given in the first two weeks after an attack. Dr Loic Burn says that it doesn't matter who does the manipulation as long as they have been trained. It can be a chiropractor, osteopath, physiotherapist or a doctor. It works equally as well and is equally as safe.

Some people try age-old remedies like sleeping with a board under their mattress. 'It's fine to try it,' says Dr Burn, 'but if it doesn't work, move on and try other things. The best approach is to stay active and be proactive in looking for something that stops the pain. Since we don't know the cause of back pain, we have to be open-minded on methods of treatment and look at every case on its merits.

'There are medical treatments that involve epidural or spinal injections but they don't always work. Spine-fusing surgery is a last resort and only given to one in 10,000 patients. It is a very radical step considering we don't understand the causes of back pain and the results aren't always wonderful,' he said.

What about alternative therapies?

Dr Burn is happy for his patients to try complementary therapies. Reflexology, Alexander Technique, yoga, shiatsu, acupuncture and aromatherapy all have their place, he says, but the important thing is to move on if they don't work and look for other remedies.

There is no evidence that these therapies work but some people undoubtedly find they help. They are harmless and they may do some good. The important thing is not to allow back pain to make you passive or chronically ill.

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