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Back painPublished by BUPA's health information team, healthinfo@bupa.com, November 2006. This factsheet is for people who have back pain, or would like information about it. Back pain is extremely common - about eight in ten people in the UK are affected by back pain at some time in their lives. Each year, close to five million working days are lost due to back pain.
About back painAcute and chronic back painBack pain, whether it's lower back pain or pain in other parts of the back, can affect anyone at any age, although people are most likely to get it between the ages of 35 and 55. If the pain lasts for less than three months, it's called acute back pain. Acute refers to how long it's lasted for rather than how severe it is. If the problem goes on for longer, it's known as chronic back pain. How the back worksThe spine is made up of many small bones called vertebrae. These are separated by discs, which allow the spine to bend. This structure of vertebrae and discs is supported along its length by muscles and ligaments. The spine threads through the centre of each vertebra, carrying nerves from the brain to the rest of the body.  Illustration of the spine Back pain in 19 out of 20 people is linked to the way the bones, ligaments and muscles of the back work together. This is called simple back pain. The pain can begin suddenly but can also come on gradually due to strain over time. Usually nothing unusual shows up in tests such as X-rays and nothing is permanently damaged. Simple back pain is most common in adults aged 35 to 55 who are otherwise healthy. The pain is often in the lower back (lumbar region), and this lower back pain may also spread to the buttocks and thighs. It will come and go at different times, and depending on your level of activity. Triggers for simple back pain, including lower back pain, include:
Your spine is a very strong part of your body and is not easily damaged. If you have back pain, it's important that you stay physically active. This is good for your back because keeping active will help speed up your recovery from simple back pain. Nine out of ten people with back pain recover completely within six weeks. Nerve root painNerve root pain is rare - it's the cause in less than one in 20 cases of back pain. It's usually caused by one of the discs in the spine bulging out from its normal position. This is called a slipped disc. Nerve root pain is normally felt in the lower part of the back. You may have pain down one or both of your legs to the calves, feet or toes. The pain is also called sciatica because the nerve that runs down each leg is called the sciatic nerve. Other causes of back painIn rare cases, there may be a more serious underlying cause of back pain, such as an problem with the spine, an infection or collapse of the vertebrae, tuberculosis or cancer. These are more likely to be the case if your back pain starts gradually, gets worse over time and seems unrelated to your level of activity. When to see a doctor about back painMost simple back pain only lasts a few days and gets better on its own. You should see a doctor as soon as possible if, as well as back pain, you have:
You should also see your doctor about back pain if:
Diagnosis of back painUsually your doctor will only need to discuss your symptoms and examine you. If the pain lasts longer than six weeks, or if your doctor suspects there is some underlying cause of the pain, then he or she may recommend more tests. These tests might include:
Your mental wellbeing can also have a role in back pain. If the condition is chronic, your doctor may recommend that you have an assessment of your wellbeing in a pain clinic. Treatment of back painSelf-help treatmentsThere are a number of steps you can take to help yourself.
MedicinesTaking a painkiller that you would normally take for a headache (eg paracetamol or ibuprofen) is usually enough to relieve simple back pain and can help you keep active. It is best to get into a routine and take this at the same time every day. Always follow the instructions on the patient information leaflet that comes with the medicine and speak to your pharmacist. Prescription-only muscle relaxants such as diazepam may help with muscle spasms. Doctors rarely prescribe these as they can be addictive. Using a hot water bottle or an ice pack on the painful area can help reduce the pain. Don't put ice directly on your skin, as this can cause an ice burn. PhysiotherapyPhysiotherapists can assess your back pain and help to relieve discomfort, increase your movement and help you manage the pain, giving you some pain relief. ManipulationOsteopathy and chiropractic are treatments involving manipulation of the spine. You should always see your GP first. Your GP may then refer you to a qualified osteopath or chiropractor. Back pain treatment at a pain clinicIf you have chronic back pain, your doctor may refer you to a pain clinic. Pain clinics work with you to help relieve your back pain by treating your symptoms and also by giving you counselling to help you deal with the pain. Epidural for back pain reliefThis is an injection of a painkiller or steroid directly into the bottom of your spine to decrease the inflammation, which may be causing the pain. Complementary therapiesThese can include:
SurgeryIf your chronic back pain isn't helped by exercises, painkillers or manipulation, then surgery is considered as a last resort. There are different types of back surgery. Your doctor will discuss the different options with you in more detail. Prevention of back painGood back care can greatly reduce your risk of back pain. To look after your back, make sure you:
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