Diagnosis

Back pain- Should I Worry?


Back pain is extremely common. It has been estimated that at least 75% of us will suffer some degree of back pain at any time in a given year.

There are a multitude of reasons why there is a high prevalence. In part, it may be a reflection of modern busy life style: stress, inactivity or lack of exercise, unhealthy diet, prolong sitting, etc

Usually the back pain episode is short lived and settles very quickly either with activity modification or with the help of ibuprofen ( if you are able to tolerate it) and paracetamol. 

The majority of back pain can be managed at home without the need to seek professional advice eg reduce or remove the provocative trigger/activity, medication (NSAID eg ibuprofen), hot/warm packs, keep active albeit at a reduced level - gone are the days when patients would be admitted in hospital for traction!

There are certain type of back pain that warrant early professional attention. These categories of back pain suffers that raise concern have RED FLAG indicators:

1. Age - as a rule children do not normally complain of continuous back pain. Persistent back pain in the under 16 yrs require medical review. Similarly, persistent back pain in the over 60 yrs require professional review and a health check

2. Unwell- back pain associated with feeling unwell which may include unintentional weight loss, lack of appetite and not eating, fever and being generally ‘run down'

3. Significant past medical history- malignancies/cancer, tuberculosis, previous spine surgery 

4. Trauma - this is worrisome as a fall from a height can potentially cause spine fractures especially if there is a background of osteoporosis 

5. Sciatica - persistent leg pain with numbness and weakness. This may be indicative of lumbar disc prolapse or pinched nerve

6. Cauda Equina Syndrome - this is a serious condition where, for example, a large disc prolapse causes so much pressure in the spinal canal and interrupts electrical flow. This can lead to leg paralysis, bladder and bowel dysfunction/incontinence, sexual dysfunction, and profound numbness in the legs and buttocks. Urgent medical review is mandatory inc MRI scan

7. Severe back pain which is not responding to regular painkillers eg ibuprofen, paracetamol, cocodamol. As a general rule, if back pain is not settling down despite taking painkillers for 72 hours, it is advisable to seek medical review 

Comprehensive examination and investigations including blood tests and MRI scans are essential in differentiating “benign" back pain from more “potentially serious “ back pain, provide reassurance and direct correct treatment. 

Caring for your back


Good back care is essential to help avoid many common spinal problems. Here are 10 sensible guidelines which can be used every day to help preserve the health of your back.

• Try to alternate between standing and sitting 
• Place a support in the small of your back when driving or sitting at a desk 
• Exercise by walking or swimming regularly 
• Try to lose weight to reduce the load on your spine and back muscles 
• Stretch regularly to reduce stiffness and increase mobility 
• Watch your posture - try not to slouch or slump 
• Be careful when lifting. Make sure the load is not too heavy or too large 
• Try frequent gentle stretches to reduce the strain on your back 
• Keep moving, even if you have an episode of back pain 
• Consider whether your bed/mattress is providing the support to your back at night 

Diagnosis 


Cervical disc herniation

When one of the vertebral discs in the neck become 'herniated' and protrudes outwardly, it places pressure on the nerve roots and results in pain in the neck, arms, and upper body.

Compression spinal fractures

Certain medical conditions - osteoporosis, multiple myeloma and metastatic disease - can make the spine more prone to fractures. 

Herniated discs

This occurs when the cushion that sits between the spinal vertebra is pushed outside its normal position, causing pain in the back or leg, or weakness of the lower extremity muscles.

Kyphosis

Is a deformity of the spine that result in a segment of it curving (flexing) more than normal. When this curving is excessive, it may result in a hunchback.

Lumbar disc herniation

Because the lower (lumbar) spine carries the bulk of the body's weight, it is very prone to injury. As discs age, they begin to degenerate and become damaged through general wear and tear or injury - when this happens, the jelly-like centre (nucleus) of the disc bulges out and a hernia results.

Scoliosis 

Is a condition that results from abnormal curvature of the spine. 

Spondylolisthesis

This condition occurs in the lower spine when a disc slips forward over the one below it, causing pain in the lower back and leg. 

Stenosis

Spinal stenosis occurs when the normally clear and open channel through which the spinal cord and nerves run becomes too narrow.

Thoracic disc herniation

When a disc degenerates (or becomes herniated), it flattens and puts pressure on the spinal cord, causing pain and irritation to the nerves. 

Instability Back pain

Causing spasm and severe pain; due to lack of internal back support such as a ‘slipped vertebra’.

Cauda equina syndrome

Severe compression of the sac of nerves in the lumbar spine, leading to paralysis, urinary and bowel dysfunction. This is a medical emergency.

Foot drop caused by back pain

Requires urgent clinical evaluation.

Back pain causing sleep disturbance and unwellness

Requires urgent clinical assessment.

Sciatica

Leg pain due to pinched nerve from disc prolapse or arthritis.

Back strain

Muscle and ligament injury that respond to reduced/altered activity, anti-inflammatories, and appropriate exercise.

Sports related back pain
Adolescent Back pain
Back pain due to infection
Post-surgical Back pain
Work related back pain
Whiplash neck pain and spine pain after accidents
Caring for your back

Good back care is essential to help avoid many common spinal problems. Here are 10 sensible guidelines which can be used every day to help preserve the health of your back: 

  • Try to alternate between standing and sitting
  • Place a support in the small of your back when driving or sitting at a desk
  • Exercise by walking or swimming regularly
  • Try to lose weight to reduce the load on your spine and back muscles
  • Stretch regularly to reduce stiffness and increase mobility
  • Watch your posture - try not to slouch or slump
  • Be careful when lifting; make sure the load is not too heavy or too large
  • Try frequent gentle stretches to reduce the strain on your back
  • Keep moving, even if you have an episode of back pain
  • Consider whether your bed is providing the support you need at night

Further information is available at: http://www.spinesurgeons.ac.uk/patients-area/patient-information/