Back Pain

I’ve done no study on this but I can safely say that back pain is one of the most common complaints coming into the pharmacy presently. Back pain comes in many forms and today we will look at these and options for treatment. Back pain can also bring a myriad of psychological complications as the invisible pain can be hard for others to understand and tolerate.

Back pain is very common and normally improves within a few weeks or months (which can totally disrupt your life especially with work or small kids). Pain in the lower back (lumbago) is particularly common, although it can be felt anywhere along the spine – from the neck down to the hips. In most cases the pain isn’t caused by anything serious and will usually get better over time. There are things you can do to help relieve it. But sometimes the pain can last a long time or keep coming back.

Causes of back pain

It’s not always possible to identify the cause of back pain but it’s rarely anything serious. Most back pain is what’s known as “non-specific” (there’s no obvious cause) or “mechanical” (the pain originates from the joints, bones or soft tissues in and around the spine).

This type of back pain:

tends to get better or worse depending on your position – for example, it may feel better when sitting or lying down
typically feels worse when moving – but it’s not a good idea to avoid moving your back completely, as this can make things worse
can develop suddenly or gradually
might sometimes be the result of poor posture or lifting something awkwardly, but often occurs for no apparent reason
may be due to a minor injury such as sprain (pulled ligament) or strain (pulled muscle)
can be associated with feeling stressed or run down
will usually start to get better within a few weeks

Medical conditions that cause back pain

Conditions that can cause back pain include:

a slipped (prolapsed) disc(a disc of cartilage in the spine pressing on a nerve) – this can cause back pain and numbness, tingling and weakness in other parts of the body
sciatica(irritation of the nerve that runs from the lower back to the feet) – this can cause pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet
ankylosing spondylitis(swelling of the joints in the spine) – this causes pain and stiffness that’s usually worse in the morning and improves with movement
spondylolisthesis(a bone in the spine slipping out of position) – this can cause lower back pain and stiffness, as well as numbness and a tingling sensation

These conditions are treated differently to non-specific back pain. Very rarely, back pain can be a sign of a serious problem such as:

a broken bone in the spine
an infection
cauda equina syndrome (where the nerves in the lower back become severely compressed)
cancer

Treatment

Back pain will usually improve within a few weeks or months. There are several things you can try to help reduce your pain in the meantime so that you can try and maintain some level of daily life. There are also some specialist treatments that may be recommended if it’s thought simple measures aren’t likely to be effective on their own. The main treatments for back pain include:

Stay active

One of the most important things you can do is to keep moving and continue with your normal activities as much as possible. It used to be thought that bed rest would help you recover from a bad back, but it’s now known that people who remain active are likely to recover more quickly. This may be difficult at first, but don’t be discouraged – your pain will start to improve eventually. Consider taking painkillers if the pain is stopping you from carrying on as normal.

There’s no need to wait until you’re completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity and may distract you from the pain.

Back exercises and stretches

Simple back exercises and stretches can often help reduce back pain. These can be carried out at home as often as you need to. For information about the types of exercises and stretches that can help, see a good physiotherapist who can advise you on the correct exercises for lower back pain and direct you to a pilates class or DVD to alleviate your particular back trouble. Doing regular exercise alongside these stretches can also help keep your back strong and healthy. Activities such as walking, swimming, yoga and pilates are popular choices and can certainly help to prevent or reduce future back complications.

Painkillers

Non-steroidal anti-inflammatory drug (NSAID) tablets, such as ibuprofen, can help relieve back pain. Grants Pharmacy stocks a range of these and their generic versions also. But NSAIDs aren’t suitable for everyone, so check in Grants first to see if they are the right choice for you. If you can’t take NSAIDs, alternative medicines such as codeine may help. This is a stronger painkiller that should ideally only be used for a few days, as it can cause addiction if used for longer. A rub on gel with an anti-inflammatory in it can also be useful, eg Diclac or Voltarol gel.

Paracetamol on its own isn’t recommended for back pain, but it may be used alongside stronger painkillers such as codeine. Muscle relaxants may be prescribed by your GP if you have painful muscle spasms in your back.

Hot and cold packs

Some people find that heat – for example, a hot bath or a hot water bottle placed on the affected area – helps ease the pain when back pain first starts.

Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area can also help in the short-term. However, don’t put the ice directly on your skin, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth first. Another option is to alternate between hot and cold using ice packs and a hot water bottle. Hot and cold compression packs are available at Grants Pharmacy.

Relax and stay positive

Trying to relax is a crucial part of easing the pain as muscle tension caused by worrying about your condition may make things worse. This is obviously easier said than done especially if everyday tasks are no longer possible due to the chronic pain. Although it is very difficult, it helps if you stay optimistic and recognise that your pain should get better, as people who manage to stay positive despite their pain tend to recover quicker. I can feel all you back sufferers throwing your eyes to Heaven after the last few lines!

Manual therapy

Manual therapy is the name for a group of treatments where a therapist uses their hands to move, massage and apply careful force to the muscles, bones and joints in and around your spine. It’s usually carried out by chiropractors, osteopaths or physiotherapists. Manual therapy can help reduce back pain, but it should only be used alongside other measures such as exercise.

There’s also some evidence that a therapy called the Alexander technique may help with long-term back pain, although the National Institute for Health and Care Excellence (NICE) doesn’t currently recommend this treatment specifically. This is essentially connecting head with body and treating the whole unit. It involves posture and alignment and can be effective.

Psychological support

Your GP may suggest psychological therapy, in addition to other treatments such as exercise and manual therapy. Therapies such as cognitive behavioural therapy (CBT) can help you manage your back pain better by changing how you think about your condition. While the pain in your back is very real, how you think and feel about your condition can make it worse. If you’ve been in pain for a long time, a specialist treatment programme that involves a combination of group therapy, exercises, relaxation, and education about pain and the psychology of pain may be advisable.

Surgery and procedures

Surgery for back pain is usually only recommended if there’s a specific medical reason for your pain, such as sciatica or a slipped (prolapsed) disc, and other treatments haven’t helped. But a procedure called radiofrequency denervation may sometimes be used if:

you’ve had back pain for a long time
your pain is moderate or severe
your pain is thought to originate from the joints in your spine

This procedure involves inserting needles into the nerves that supply the affected joints. Radio waves are sent through the needles to heat the nerves, which stops them from sending pain signals. You’re awake while the treatment is carried out and local anaesthetic is used to numb your back. You won’t need to stay in hospital overnight. As with all procedures, radiofrequency denervation carries a risk of complications, including bleeding, bruising, infection and accidental nerve damage.

You should contact your GP or A&E immediately if you have back pain and:

numbness or tingling around your genitals or buttocks
difficulty peeing
loss of bladder or bowel control
chest pain
a high temperature (fever) of 38C (100.4F) or above
unexplained weight loss
a swelling or a deformity in your back
it doesn’t improve after resting or is worse at night
it started after a serious accident, such as after a car accident

These problems could be a sign of something more serious and need to be checked urgently.

Preventing back pain – reduce your risk

It’s difficult to prevent back pain, but the following tips may help reduce your risk:

do regular back exercises and stretches– a physiotherapist may be able to advise you about exercises to try
stay active – doing regular exercisecan help keep your back strong; adults are advised to do 30 minutes of fast exercise each day. Swimming and yoga or pilates are especially good for the lower back. Even 10mins of simple lower back exercises each day can make a massive difference to back strength and future-proof your back health.
avoid sitting for too long when driving or at work
take care when lifting – read some safe lifting tips
check your posture when sitting, using computers and watching television – find out how to sit correctlyand tips for laptop users
ensure the mattress on your bed supports you properly
lose weightthrough a combination of a healthy diet and regular exercise if you’re overweight – being overweight can increase your risk of developing back pain

When medication is taken as directed with recommended lifestyle changes, such as changing your exercise regime and posture, many people reduce their back pain to levels that are tolerable. Please feel free to call into any Grants Pharmacy to discuss your back pain or any other ailment for free and in private with your Pharmacist. We will be happy to advise you on your best course of treatment. Grants Pharmacy is located in Wexford town, in Enniscorthy town, in Arklow town – all beside Pettitts and in Gorey town opposite the GPO. Find us on Facebook

About the author

Susan