Recently, we did a post on chronic pain and ways to manage it. What struck us were the statistics on back pain. According to the Australian Institute of Health and Welfare, 3.7 million Australians reported back problems and it has become the 3rd leading cause of disease burden after cancer and cardiovascular problems. They are most common in the 65-79 age group, but GPs are reporting an increasing number of younger people with back pain. Long working hours and obesity are some contributing factors.
What is back pain?
Generally defined as pain in the lower, middle and upper back, it can be caused by injury, repeated strain or changes in the spine, some of which are:
- Narrowing of the canal through which the spinal cord passes
- Degeneration of the spine, spinal disc
- Pressure on a spinal nerve, etc.
Understanding the structure of the spine is important to understanding the pain. The spine is a column of 33 bones (vertebrae) and connective tissue going from the skull to the pelvis. The spinal cord runs in a channel between these bones. Between each one of these 33 bones is a disc that acts as a cushion. Anything that destabilises this column could result in back pain. It’s classified into two major categories:
- When one of the vertebra slips – it is Spondylolisthesis
- When there is nerve damage due to compression of the cervical vertebrae – it is Cervical Radiculopathy
The result of either can many conditions – spinal stenosis, sciatica, ankylosing spondylitis, piriformis syndrome….it is a long list.
What causes back pain?
Let’s look at some of things that cause back pain. Usually the cause is the wrong way we may be going about our routine activities:
- Poor posture – so many of us suffer from this. Slouching when we are sitting, watching TV or reading. And if we are doing this for many hours in a day, that can lead to chronic pain.
- Overexertion – at work or play. Long hours at the desk, slouched over a keyboard or pushing yourself too hard at the gym can cause long term damage to the back muscles.
- Lifting heavy objects carelessly: Our everyday lives involve a fair bit of pulling, pushing and carrying weight. Done carelessly, it can result in strained back muscles. A tear or inflammation can result in severe pain and a long period to recovery.
- Poorly designed furniture: An office chair that is bad for your back, a pillow that does not provide good neck support or a sagging mattress – furniture is a big reason for back problems.
How is back pain diagnosed?
Because back pain could be a combination of what’s affecting bones, muscles and nerves, tests are done with the usual medical imaging technology, but are often combined with other tests. If your back pain does not respond to rest and pain-killers for a few weeks (5-6 weeks being the norm), your GP may recommend diagnostic tests to determine the root cause of the pain. Some tests are:
- X-ray: which will show any instability in the spinal structure, tumours or fractures. However, these tests won’t detect any issues with discs or nerve roots.
- CT scans: being cross-sectional they provide a much better view of the spine and are used for detecting a lumbar disc herniation or spinal stenosis.
- CT scan with a myelogram: a GP may recommend a CT with a myelogram, if nerve damage is suspected (for instance pain in the legs). The myelogram consists of a dye injection that highlights nerve roots in the scan.
- Electromyography: Back pain can be caused by nerve root compression and nerve degeneration. An electromyography can identify which of the two is causing pain.
Treatment pathways for back pain:
Sometimes surgery is the only way out. But for those not needing surgery, treatment pathways for back pain, particularly the severe and chronic kind, have now evolved to more than just painkillers and physiotherapy. Management plans are increasingly holistic and look at patient well-being rather than treat just the pain point. Non-invasive back pain treatment pathways are:
- Non-drug pain management: Depending on the cause and severity, your GP and pain management specialist may recommend one or a combination of these treatments:
- Electrotherapy – the most common one is TENS, where nerves are given by low voltage electric stimulation.
- Hot and cold pads – recommended in conjunction with exercise they are used to reduce inflammation and bring pain relief to those with chronic pain
- Manual techniques – often administered by a physiotherapist or qualified masseuse by applying pressure to joints, muscles and ligaments. The aim is to improve blood flow to these areas.
- Exercise – this is not just any exercise but a programme that targets the bad back. This includes hydrotherapy, the McKenzie method, stretching and aerobic routines. These are best done under qualified supervision.
- Behavioural modification: simply put, this is way of helping a patient self-treat. The cognitive therapy aims at teaching the patient to respond to back pain by relaxation techniques, controlling muscle tension etc.
- Pain management with medication: Your GP may recommend some painkillers along with non-drug techniques like exercise and electrotherapy. The drugs used could be:
- Analgesics – some of these are OTC drugs and contain acetaminophen. They provide quick relief from debilitating pain. These are not recommended for long term use due to the risk of kidney and liver damage.
- Anti-inflammatory medication – which contain aspirin, ibuprofen. Sustained use could result in ulcers for some patients.
- Narcotic medication – typically GPs recommend this only for very acute pain, often post-surgery. Rarely used for chronic pain management as the risk of addiction is high.
If you’ve had back pain that has gone on for more than a couple of weeks and is starting to affect your work or personal life, speak to your GP. There is a wide choice of treatment pathways and your GP will recommend the one that works best for your situation.