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Back pain

Back pain is extremely common and can affect anyone at any age, but it's most common in people between the ages of 35 and 55.

 

'Acute' and 'chronic' are terms used to describe how long the symptoms last, not how severe they are.

  • Acute back pain - less than six weeks
  • Sub-acute back pain - six weeks to three months
  • Chronic back pain - longer than three months

How your back works

Your spine is made up of many small, inter-connected bones called vertebrae. These are separated by strong connectors called discs, which act as shock absorbers and allow the spine to bend. Your spine is supported along its length by muscles and ligaments. Your spinal cord threads down through the centre of each vertebra, carrying nerves from your brain to the rest of your body.

Causes of back pain

There isn't usually an underlying condition causing back pain - nothing shows up in tests and nothing is permanently damaged. This is called simple or non-specific back pain. Nine out of 10 people with simple back pain recover completely within six weeks.

You're more likely to develop simple back pain if you:

  • stand, sit or bend down for long periods
  • lift, carry, push or pull loads that are too heavy, or if you go about these tasks in the wrong way
  • have a trip or a fall
  • are stressed or anxious
  • are overweight

Occasionally, there may be a more serious underlying cause of your back pain, but this is rare. These causes include osteoporosis, a prolapsed (slipped) disc, spinal stenosis, malformation of the spine, infection or collapse of the vertebrae, tuberculosis or cancer.

Symptoms of back pain

Simple back pain is often in your lower back (lumbar region), and may also spread to your buttocks and thighs. It's often described as a dull pain and can come and go at different times, depending on your level of activity. The pain can begin suddenly or come on gradually if you strain your back over time.

Simple back pain usually only lasts a few days and gets better on its own.

However, you should see your GP as soon as possible if, as well as back pain, you have:

  • 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)

Some symptoms are called "red flags" and may indicate that you require treatment for an underlying condition. You should see your GP if:

  • your pain is the result of an injury
  • you're under 20 or over 55 and the pain lasts for more than a few days
  • you have had or currently have cancer in any part of your body
  • you have HIV/AIDS
  • you have been taking steroid medicines for more than a few months

Diagnosis of back pain

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

If your pain lasts longer than six weeks, or if your GP suspects there is some underlying cause of your pain, he or she may recommend more tests such as:

  • X-rays
  • CT scans - a CT scan uses X-rays to make a three-dimensional image of the body/or part of the body
  • MRI - an MRI scan uses magnets and radiowaves to produce images of the inside of your body
  • blood tests

Treatment of back pain

Self-help

There are many things you can do to help yourself.

  • Stay active - return to your usual level of physical activity as soon as possible. This may hurt more at first, but it will help you get better and reduce your risk of getting simple back pain again.
  • Bed rest - if the pain is so bad that you can't get moving, keep the time you stay in bed as short as possible. Lying in bed can do more harm than good.
  • Stay positive and set yourself goals - this will help you get back to your usual levels of physical activity.
  • Heat therapy - apply a hot water bottle or heat pack directly to the affected area, or take a hot bath.
  • Ice therapy - 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 because you could damage it.
  • Pace yourself - be careful not to overdo it when your pain improves.

Medicines

Taking a painkiller (such as aspirin or paracetamol) or anti-inflammatory medicine (such as ibuprofen) is often enough to relieve simple back pain and can help you keep active. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients that can be applied directly onto the painful area.

If your pain continues, your GP 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.

Your GP or pharmacist will advise you which treatment is the most appropriate for you. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice.


Transcutaneous electrical nerve stimulation (TENS)

TENS relieves back pain by delivering mild electric pulses to the painful area through electrodes on your skin. These stimulate your nerve fibres and block the pain signals to your brain. TENS isn't suitable for everybody and isn't always effective. You should check with your GP before you use TENS and make sure you know how to use it properly.

Physiotherapy

Physiotherapists can assess and treat your back pain, and teach you exercises to do at home that will increase your mobility and help you manage your pain. You should only see a physiotherapist registered with the Chartered Society of Physiotherapy.

Manipulation

Osteopathy and chiropractic are treatments involving manipulation of the body, mainly focusing on the spine. They are most useful if you have had back pain for less than three months and can provide short-term (most often) or long-term pain relief. These treatments aren't suitable for everybody and aren't always effective, so it's important to speak to your GP first. You should only see an osteopath registered with the General Osteopathic Council or a chiropractor registered with the General Chiropractic Council.

Pain clinics

If your pain continues, your GP may refer you to a pain clinic. Pain clinics offer a range of treatments that are known to be effective and can also help you deal with your pain by changing the way you think about it. Treatments at pain clinics are often combined and tailored to suit your needs.

Injections

Painkillers and anti-inflammatory medicines (usually steroids) can be injected directly into the epidural space (the space around your spinal cord) or around the joints of your spine to ease pain and decrease inflammation. These injections are only given by specialist doctors in hospitals. Epidural injections are usually only done if other treatments don't work.

Surgery

Surgery is considered as a last resort in the treatment of back pain. The type of surgery you're offered will depend on the cause of your pain and each type has different risks and success rates. Your surgeon will discuss the different options with you in more detail.

Complementary therapies

The following complementary therapies may help with back pain in some people. You should talk to your GP before trying them as he or she may be able to refer you to a specialist practitioner experienced in treating back pain.

  • Acupuncture
  • Counselling
  • The Alexander Technique - becoming more aware of your body's balance, posture, and movement
  • Herbal remedies
  • Massage

Prevention of back pain

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

  • take regular exercise - walking and swimming are particularly recommended
  • try to reduce your stress levels - use relaxation techniques
  • bend from your knees and hips - not your back
  • maintain good posture - keep your shoulders back and don't slouch
     

Further information

BackCare
0845 130 2704
www.backpain.org

Chartered Society of Physiotherapy
www.csp.org.uk

General Osteopathic Council
www.osteopathy.org.uk

General Chiropractic Council
www.gcc-uk.org

Sources

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.