Back pain

Back pain is very common. Hundreds of thousands of people in the UK suffer from back pain in any one year and most handle their back pain themselves. Symptoms of back pain depend on the cause, whether the pain arises from the spine and surrounding muscles, or a nerve that’s trapped at its root so that pain radiates down the nerve to their leg and on to their foot (sciatica). Less than one in a hundred cases of back pain is due to a serious spinal disease such as a tumour or infection.

Causes of someone suffering from back pain include: poor posture - sitting hunched up, bad lifting techniques of heavy objects, being overweight, having arthritis or wear and tear of their joints, ankylosing spondylitis, a slipped or prolapsed disc in their spine, or thinning of their bones (called osteoporosis).

There are some well recognised ‘red flags’ that could indicate to a doctor that a person’s back pain is serious and requires prompt action. This might be when they’ve had a significant injury such as a road traffic accident or fall from a height, have cancer elsewhere, are generally unwell, have had unexplained weight loss, have difficulty urinating or widespread nerve pain.

A person’s psychological state can affect how quickly they get better and whether back pain recurs. They might be fearful that their back pain is harmful or potentially severely disabling, or over-react by avoiding movement as they fear triggering further back pain.

Q1.I’ve just been to see my GP because of the awful back pain I’ve had for the last fortnight. They’ve prescribed me painkillers but refused to arrange an Xray. Is that because the NHS needs to save money?

A.Routine Xrays are not recommended for investigating low back pain lasting less than six weeks, unless there are unusual signs that alert the doctor to it being a serious disease.  An Xray of the spine involves 120 to 150 times the radiation dose of having a chest Xray. The advantages of having a back Xray when you’ve only been in pain for a short time are not worth the risks. Your doctor is right.

Q2. I work as gardener which involves some heavy lifting and then I get a week or two of back pain. I’m fed up of taking paracetamol for it. Should I go to see a hospital specialist who could consider operating on my spine and stop my back problems?

A.Surgery is rarely recommended. Spinal surgery is for the treatment of nerve root problems that are not getting better or where nerve compression is so great that the person has difficulty urinating, retaining their faeces, and has widespread loss of sensation and muscle tone around the genital area and legs (the ‘cauda equina’ syndrome). So take care when you’re lifting heavy objects at work to bend your knees and lift with a straight back- paracetamol every so often is a much safer option than surgery.