For BackCare Awareness Week, Dr David Ward, GP with a special interest in Musculoskeletal at Medical Solutions, explains how to prevent and treat back pain.
Back pain is a common disorder and almost everyone is affected by it at some stage in their lives. For most people the period of substantial pain and disability is short-lived and they will return to normal daily activities regardless of what treatment or advice is given. It’s estimated that almost 90% of people with sciatica will get better by themselves within a six-week time span.
A small proportion of people will go on to develop chronic symptoms. Once it has been there for over a year, few people with long term pain and disability return to normal activities. These people account for the majority of the health and social costs attributable to back pain care.
The Impact of Back Pain
Lower back pain affects one-third of the UK adult population every year. Of these people, 20% will consult their GP, which means over 2.6 million adults will need at least one GP appointment.
In 2018 The British Pain Society stated that back pain alone accounted for over 40% of staff absences in the NHS.
Overall the cost of absences due to back pain costs almost £500 per year per employee and may cost the UK economy over £10bn. Back pain may be non-specific, with tension, soreness and stiffness and no identifiable cause found; or it may be due to a specific cause such as trauma, fractures in osteoporosis, infection, inflammation or malignancy.
Treatments are based on diagnosis and the chronicity of the problem. They can be divided into non-pharmacological (management of pain without medicine), pharmacological (management of pain with medicine) and interventional (using pain-blocking techniques):
-Non-pharmacological can involve home exercise programmes, physiotherapy (or osteopathy/chiropractic), psychological therapies and return to work programmes.
-Pharmacological therapies start with nonsteroidal anti-inflammatory drugs such as ibuprofen and weak opiates such as codydramol, but for short periods of time and not for long term management.
There is no place for regular paracetamol in back pain, nor high dose opiates. Longer-term treatment may include the use of neuropathic medications especially if sciatica is a feature.
Interventions may include radiofrequency denervation (a specialised injection, which uses heat to alter the function of the nerves that transmit pain) or epidurals (an injection to numb the feeling of pain) for those with severe sciatica. Surgery itself is reserved for those who have a neurological disability related to back conditions and not for pain in itself.
Alternative therapies are available but at present are not recommended by the NICE (National Institute for Health and Care Excellence) guidelines.
Prevention: 7 ways to prevent back pain
Prevention is always better than cure and there are simple preventative steps that can be taken:
- Regular back exercises and stretches can be found online or can be recommended by physiotherapists
- Regular weekly moderate exercise of at least 150 minutes, as currently recommended for general good health
- Avoid sitting for too long when travelling, working on a computer or watching television
- Take care when lifting objects. Each workplace will have guidance on the optimum way to lift objects
- Take care with posture, especially when sitting
- Get a good mattress for support while sleeping
- Weight loss or weight control with diet and exercise. People who are overweight suffer substantially more from back pain
There is a huge amount of information to be found online. Most large organisations like NICE and the The British Pain Society have easily accessible websites. Good information and links can also be found on the NHS website.
Of course, prevention can never stop some of the rarer forms of back pain or unexplained trauma, however, these simple steps can help reduce the chances of suffering from this debilitating disorder.
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