What is Back Pain?
Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine. If the pain is situated in the lower back and is bearable, most people will try some form of home remedy and gentle exercise before going to their GP. However, if the pain does not improve within a six-week period, a visit to the doctor is advisable.
What are the Symptoms of Back Pain?
If any of the following warning signs are present along with lower back pain, it is important to see your doctor without delay:
- Difficulty passing urine or opening the bowels.
- Numbness around the back passage.
- Weight loss or high fever.
- Pain which is continuous and persists throughout the night.
- A marked feeling of stiffness first thing in the morning.
- A very numb, wooly type of feeling in the legs on walking, which improves when you stop and bend forwards.
- The first two symptoms outlined above may suggest that pressure is being placed on the bundle of nerve fibres known as the cauda equina, which stretch down towards the sacrum and coccyx, or tailbone. While this is quite rare, it requires immediate treatment when it occurs.
- The next three symptoms may be early warning signs of the onset of arthritis or a tumour on the spine, while the last symptom may be caused by narrowing of the vertebral canal through which the spinal cord runs. This condition is referred to as Spinal Stenosis.
What are the Causes of Back Pain?
Back pain can start in any part of the spinal column, but the most common type of pain experienced is in the lower back. This is because the lower back (or lumbar spine) is the area which bears the most weight and is subjected to more twisting, turning and straining than any other part of the back.
Mechanical back pain is usually caused by factors which can be corrected such as bad posture; incorrect footwear; badly-designed seating, poor lifting techniques and lack of exercise, while the more serious causes of back pain will usually require medical intervention.
Traditional Medical Treatments for Back Pain
The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore the individual’s ability to function in everyday activities; to help the patient cope with residual pain; to assess for side-effects of therapy. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long term pain relief. Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better.
Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of back pain patients (most estimates are 1% – 10%) require surgery.
Complementary/Alternative Treatments for Back Pain
- Massage therapy, especially from an experienced therapist, may help. Acupressure or pressure point massage may be more beneficial than classic (Swedish) massage.
- Body Awareness Therapy such as the Feldenkrais Method has been studied in relation to Fibromyalgia and chronic pain and studies have indicated positive effects. Organized exercise programs using these therapies have been developed.
- Manipulation, as provided by an appropriately trained and qualified chiropractor, osteopath, physical therapist, or a physiatrist. Studies of the effect of manipulation suggest that this approach has a small benefit similar to other therapies and superior to placebo.
- Acupuncture has a small benefit for chronic back pain. The Cochrane Collaboration concluded that “for chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and alternative treatments.”. More recently, a randomized controlled trial found a small benefit after 1 to 2 years.
- Education, and attitude adjustment to focus on psychological or emotional causes – respondent-cognitive therapy and progressive relaxation therapy can reduce chronic pain.
- Most people will benefit from assessing any ergonomic or postural factors that may contribute to their back pain, such as improper lifting technique, poor posture, or poor support from their mattress or office chair, etc. Although this recommendation has not been tested, this intervention is a part of many ‘back schools’ which do help.