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Patient Guide to Back Pain

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Back pain is extremely common – about four in five people are affected at some point in their lifetime. Anyone can get back pain at any age, but it’s most common in people between the ages of 35 and 55, or over.

Your back has many interconnecting structures, including bones, joints, muscles, ligaments and tendons. Its main support structure is the spine, which is made up of 24 separate bones called vertebrae, plus the bones of the sacrum and coccyx. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads down through the central canal of each vertebra, carrying nerves from your brain to the rest of your body.

It’s often very difficult to know exactly what causes back pain, but it’s usually thought to be related to a strain in one of the interconnecting structures in your back, rather than a nerve problem. Back pain caused by a more serious, underlying condition is rare and you’re unlikely to be affected unless you are very old or very young.

Spinal Stenosis

Symptoms of Low Back Pain

If you have low back pain, you may have tension, soreness or stiffness in your lower back area. This pain is often referred to as ‘non-specific’ back pain and usually improves on its own within a few days.

Back pain may be called either ‘acute’ or ‘chronic’ depending on how long your symptoms last. You may have:

  • acute back pain – lasting less than six weeks
  • sub-acute back pain – lasting six weeks to three months
  • chronic back pain – lasting longer than three months

You should see a doctor as soon as possible if, as well as back pain, you have:

  • a fever (high temperature)
  • redness or swelling on your back
  • pain down your legs and below your knees
  • numbness or weakness in one or both legs or around your buttocks
  • loss of bladder or bowel control (incontinence)
  • constant pain, particularly at night
  • pain that is getting much worse and is spreading up your spine

These symptoms are known as red flags. It’s important to seek medical help for these symptoms to ensure you don’t have a more serious, underlying cause for your back pain.

For most people with back pain, there isn’t any specific, underlying problem or condition that can be identified as the cause of the pain. However, there are a number of factors that can increase your risk of developing back pain, or aggravate it once you have it. These include:

  • standing, sitting or bending down for long periods
  • lifting, carrying, pushing or pulling loads that are too heavy, or going about these tasks in the wrong way
  • having a trip or a fall
  • being stressed or anxious
  • being overweight
  • having poor posture

There may be other, more serious underlying causes of your low back pain, but these are rare. They include:

  • fracture – a crack or break in one of the bones in your back
  • osteoporosis – a condition where bones lose density causing them to become weak, brittle and more likely to break
  • a slipped disc – this is when a disc bulges so far out that it puts pressure on your spinal nerves
  • spinal stenosis – a condition in which the spaces in your spine narrow
  • spondylolithesis – when one of your back bones slips forward and out of position
  • degenerative disc disease – when the discs in your spinal cord gradually become worn down
  • osteoarthritis – a wear-and-tear disease that can particularly affect the joints of your spine
  • rheumatoid arthritis – an inflammatory condition in which your immune system causes inflammation of the lining of your joints and surrounding structures

Low back pain may also be caused by an infection or cancer, but these two causes are very rare.

Diagnosis of back pain

A doctor will usually be able to diagnose low back pain from your symptoms and there will be no need for further tests. If, however, your symptoms don’t improve after a few weeks, or you have some red flag symptoms, he or she may refer you to have:

  • an X-ray
  • a CT scan (a test that uses X-ray equipment and computer software to create pictures of the inside of your body)
  • an MRI scan (a test that uses magnets and radiowaves to produce images of the inside of the body)
  • blood tests

These tests are used to find out if you have a more specific, underlying cause for your back pain.

Please note that availability and use of specific tests may vary from country to country.

Treatment of back pain

If your back pain is non-specific, your doctor will recommend you try self-help measures. Alternatively, he or she may prescribe medicines or refer you for physical therapy if your pain is severe or chronic. If, however, your doctor suspects you have a specific underlying cause, he or she may refer you to have spinal injections. These are used to find out the exact source of, and also to treat, your back pain but aren’t suitable for everyone.

Self-help

There are a number of things you can do to help relieve low back pain.

  • Stay active and continue your daily activities as normally as you can. Bed rest may actually make low back pain worse, so try to limit the time you spend resting to a minimum.
  • Apply hot or cold packs to the affected area. You can buy specially designed hot and cold packs from most pharmacies. If you prefer, you can apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. Don’t apply ice directly to your skin as it can damage your skin.

Medicines

Taking an over-the-counter painkiller such as aspirin (acetylsalicylic acid) or paracetamol (acetaminophen), or anti-inflammatory medicine such as ibuprofen is often enough to relieve acute low back pain. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your pain is severe or chronic, your doctor may prescribe stronger medicines such as diazepam, morphine or tramadol. However, these aren’t suitable for everyone because they can be addictive and cause side-effects. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Physical therapies

A physiotherapist (physical therapist – a health professional who specialises in maintaining and improving movement and mobility) may be able to help you design a programme to help you exercise and stretch.

Alternatively, your doctor may refer you for physical therapy such as chiropractic treatment or osteopathy (therapies that are given alongside conventional treatments) to help with your back pain. Treatment can involve exercises, posture advice, massage, and techniques known as spinal mobilisation and spinal manipulation.

Surgery

Back pain, even if it’s chronic, can usually be treated or managed successfully, but about one in 10 people have ongoing problems. Back surgery is really only considered as a last resort if the pain is related to a specific cause.

Complementary therapies

Some people find acupuncture can help relieve low back pain.
Alternatively, you could try a pain-management programme to help you better deal with and manage your symptoms.

You should always talk to a doctor before trying any complementary therapy.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of back pain

Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:

  • take regular exercise – walking and swimming are particularly beneficial
  • try to keep your stress levels to a minimum
  • bend from your knees and hips, not your back
  • maintain good posture – keep your shoulders back and don’t slouch

CURE YOUR BACK PAIN TODAY. CALL +65 6471 2744 or SMS to +65 92357641 FOR APPOINTMENT

Back Pain

Most people suffer from mild back pain from time to time and the exact cause of which may be difficult to diagnose. It is usually a sign that one or more muscles, joints, ligaments or discs are over-stretched or twisted by movement of the back in an awkward position. Severe pain may be the result of pressure on nerves from the misalignment of the bones in the back and warrants immediate medical attention.

Low back pain afflicts some 80 % of the adult population some time or other in their lives.

Many episodes of pain last only several hours or a day or two. By and large, 90% of patients should have recovered from their initial attack of pain by 6 weeks from the onset.

Symptoms

Early medical attention is necessary if certain symptoms (“red flags”) are present:

  • Constant pain with no significant relief at rest
  • Aggravated by bending in all directions
  • Localisable severe pain to a single spot on the back
  • Progressively severe pain over days/weeks
  • Persistent nerve pains, pain or sensation of numbness, pins & needles aching in one or both legs
  • Weakness of legs, difficulty in walking, unsteady walking
  • Bladder/bowel problems associated with back pain (difficulty in passing urine – incontinence)
  • General symptoms of poor health, loss of appetite, weight loss, lethargy, fever and chills
  • Previous history of cancer

Treatment

Rest is very crucial for patients with episodic attacks of back pain. Rest here may involve going home and lying down for a few hours, or it may be as simple as keeping the back straight and avoiding further stress to the back in the form of bending, lifting and sitting. In severe attacks, lying down for a day or two may significantly reduce the severity of the pain. If it does not, further bed -rest is not helpful.

Physical therapy is very important in the treatment and prevention of low back pain. In the initial period of acute back pain, combinations of heat, traction, manual treatment, and other techniques may help to rapidly reduce the severity of pain and stiffness. As pain subsides, exercises, to relieve stress and strengthen the back ,are gradually introduced. Regularity of such exercises can help to further reduce the pain, as well as protect the back from unhealthy stress and recurrent attacks of pain.

Different types of medications may be prescribed for different types of back pain.

In acute sciatica or leg pain associated with back disorders, the acute irritation of the nerve may be reduced by taking NSAIDS regularly for a short period of time. NSAIDS are often prescribed purely for pain relief rather than for anti-inflammatory effects. It is based on an as-required basis. These drugs are to be avoided if there is a history of allergy and kidney problems. In most cases, NSAIDS are well-tolerated, though most of them provoke gastric symptoms. The doctor must always be consulted.

Muscle relaxants help to reduce muscle spasm and stiffness that occurs during a pain attack. Sedatives and tranquilisers may be taken at night to ensure a restful sleep.

Ice packs, hot packs or heating lamps, ointments that usually contain methyl -salicylate and medicated plasters of various kinds may help.

30 – 40 % of patients suffer a relapse during the first few months following the attack. It is important to identify the factors that aggravated the pain.

I have severe back pain and sciatica that has not improved even with treatment. What should I do?

X-rays of the low-back should be obtained. Conditions like spondylolisthesis, infection and tumour should be excluded. Sophisticated imaging techniques such as MRI ( magnetic resonance imaging) may be required . MRI scans can show the severity of a prolapsed disc and more importantly , the degree of the nerve compression, if any. Other investigations such as bone scan, CT scans or myelograms may be performed in certain conditions.

Prevention

Recommendations for prevention of low back pain:

  • Try to modify the activity so that it is less likely to strain the back
  • Interrupt a repetitive task frequently by standing and stretching. This helps to reduce the stress on the back from building up to critical levels
  • Exercise programmes must be balanced to exercise all parts of the body, including the back.
  • Exercises should be done frequently in measured doses.

Slipped Disc

As a person gets older, a process called degeneration, the nucleus in the lower few discs of the low back . As a result , the discs are less capable of cushioning the spine , especially during repeated stressful activities. The capsule or annulus can then tear and cause pain. This is known as a slipped disc.

In a slipped disc, the annulus tears with different degrees of severity. Small tears heal quickly. Large tears can cause a small portion of the nucleus herniating through the tear to lie outside the wall of the disc. If this herniation is close to a nerve, intense irritation of the nerve can occur. “Sciatica “or feelings of pain, aching, numbness, “coldness ‘, paraesthesia or pins and needles of the thigh and calf may occur. This can involve one or both legs. Properly performed manual treatment using massage, mobilisation and manipulation may often be helpful in reducing the severity of low back pain.

Most cases recover without the need for surgery. As mentioned earlier, 90 % patients recover within 6 weeks. However a small group of patients have a significant portion of the nucleus that has herniated out of the annulus of the disc to compress the nerve and removal of the herniated fragment of disc will result in more rapid recovery of symptoms than without.

Frequently Asked Questions

Aside from a prolapsed disc, what other causes of recurrent back and leg pains are there?

Spinal canal stenosis and spondylolisthesis are 2 other common causes of recurrent back and leg pains . In older people, a condition termed as lumbar spondylosis, ( the facet joints of the spine can wear out ) can result in episodic back pains. Osteoporosis or softening of the bones can occur in the elderly, resulting in back pains. Patients who have had a previous history of cancer elsewhere, and having persistent back pains, should seek a medical opinion. Less commonly conditions such as rheumatoid arthritis, ankylosing spondylosis and various types of infections can also afflict the spine.

My back is often sore at the end of a day’s work. How can I prevent this?

Modification of activity or the work environment may be required. It is often how the person does that results in unnecessary stress to the back. Such instruction can be provided by the doctor or the therapist , either as an individual or in groups of patients attending “Back Care ” classes.

I am already doing a full day’s work. I also jog and play tennis Why do I need other exercises?

Work, no matter how strenous, is not exercise. In fact, some jobs especially those that involve repeated lifting or bending, or prolonged standing or sitting, add to the stress over the spine. Jogging, racquet games, golf, etc. may be good for general health and fitness but do not significantly exercise or strengthen the back. A balanced programme which includes improving the flexibility and strength of the back will help to prevent recurrent injuries.

STOP your Back Pain today! Call +65 6471 2744 or Email to: info@boneclinic.com.sg for Appointment