BACK PAIN - THE BASICS

Back pain is not a disease in itself. It is a collection of symptoms that signifies something is wrong. If managed properly, back pain can resolve within a matter of days or weeks.

WHAT IS PAIN?
We all know what pain means to us but it is often a very difficult thing to describe. Pain can be defined as an unpleasant sensation that occurs when we experience trauma or damage to our bodies. Pain may be aching, burning, throbbing, shooting, tingling or stabbing.

WHEN DOES PAIN BECOME A PROBLEM?
Pain becomes a proble to us when it affects the way in which we live our lives. This is usually because it lasts a long time, or becomes chronic.

DIFFERENT TYPES OF PAIN
There are three major types of pain - acute, nociceptive, inflammatory and neuropathic.

• Bee stings and twisted ankles are examples of nociceptive pain. This is pain that occurs following damage to the bones, joints, skin or soft tissue of the body.
• Pain in the joints caused by rheumatoid arthritis is an example of inflammatory pain
  
  

• Headaches and trapped nerves can be neuropathic in their origin. Neuropathic pain usually follows damage to nerve tisues.

Pain is also described in terms of how long it lasts. Acute, or short-lasting, pain is pain that lasts for less than 8 weeks and chronic, or long-lasting, pain generally lasts for more than 2 months. This is true no matter where the pain is, or what's causing the pain.

Acute pain is important because it warns us of the potential for or extent of an injury, allowing us to adapt our behaviour accordingly. In contrast, chronic pain does not serve a protective, or adaptive purpose. Instead, it disrupts our sleep and our normal way of living.

WHAT IS BACK PAIN?
Most back pain is simple back pain (or backache), pain that is linked to the way in which the bones, ligaments and muscles of the back work together. This is usually pain that:

• occurs as a result of lifting, bending or straining
• comes and goes
• most often affects the lower back
• does not usually signify any permanent damage.

Some back pain is linked to nerve root pain. This is much less common than simple back pain and accounts for about 5% of back pain cases. Nerve root pain is usually caused by compression of the start of a nerve as it leaves the spinal cord. Herniated discs (commonly, but incorrectly, called 'slipped discs') are one cause of nerve root pain.

Sciatica in which the sciatic nerve that runs down the legs becomes irritated- is a relatively common example of nerve root pain.

SYMPTOMS OF BACK PAIN
Pain itself is a very subjective feeling and its perceived severity is highly influenced by personal opinion and the circumstances under which it occurs. The symptoms of back pain can vary hugely from one person to the next. They include:

• aching
• stiffness
• numbness
• weakness
• tingling (pins and needles)
  

Coughing or sneezing can often make back pain much worse by causing the muscles of the back to go into painful spasm. The pain may start in your back but may travel elsewhere. It often goes into the buttocks, but may go further down the leg and even into the foot. If pain gets really bad, or lasts for a long time, you may experience:

• difficulty passing urine
• difficulty sleeping
• sexual problems

WHAT CAUSES BACK PAIN?
There are a whole host of reasons why you might experience back pain. Your pain might be a consequence back pain. Your pain migh be a conseguence of everyday life (such as bad posture whilst driving or sitting at your desk) or, less often, it might be as a result of some underlying disease. The majority of cases of back pain are linked to simple mechanical problems, less than 5% signify nerve root pain and less than 2% reflect serious spinal pathology.

Back pain can be felt as a result of (most likely first):

• sprains ( an injury to the ligament of a joint)
• injury (eg. a car or sport accident)
• muscle damage (eg. from over-exercising)
• fractures caused by underlying bone disease (eg. osteoporosis)
• underlying inflammatory disease (eg. rheumatoid arthritis)
• degenerative diseases (eg. fibromyalgia)
• cancer (eg. prostate and pancreatic cancer)
• infections (eg. bladder infections and spinal infections like tuberculosis)

Simple back pain can be worsened, or triggered, by a number of factors including:

• poor posture
• a lack of exercise
• standing or bending down for long periods
• sitting on an unsuitable mattress
• driving for long periods without a break
• being overweight
• being pregnant
• lifting, carrying, pushing or pulling loads that are too heavy

THE WRONG WAY TO LIFT

WHEN SHOULD I SEE A DOCTOR ABOUT MY BACK PAIN?
Most simple back pain gets better on its own after only a few days. Simple painkiller may keep the pain under control (provided they are used as directed on the dosing instructions).

However, you should consult your GP if your pain lasts longer than a week or is as a result of a fall or a blow to the back (eg. a car accident or sport injury).

You should also consult your doctor if your back pain is accompanied by any of the following symptoms:

• a high temperature
• redness or swelling
• pain down the legs and below the knees
• numbness aor weakness in one or both legs
• loss of bladder or bowel control (can indicate pressure on the spinal cord)

DIAGNOSING BACK PAIN
In majority cases, your doctor will be able to work out what is wrong by examining you and asking you to descsribe what you back pain feels like. However, one of the biggest problems with pain is that sometimes we do not have the words to describe it. Rating pain on a scale of 1 to 10 may help you to describle it more easily.

If your pain lasts longer than it should , or if your doctor suspects that there may be other reasons for your pain, you may be referred for further tests and a specialist.

X-rays

• Shows wear and tear of the spine and broken bones

Blood Tests

• Can help to identify very specific causes of pain (eg. infection, tumours, arthritic diseases)

CT and MRI scans

• Provide detailed pictures of bone and surrounding tissues. Can be used to rule out serious diseases.

Even after performing these tests, it may still be unclear why you are in pain. This does not mean that your pain is not genuine or would not be taken seriously, or that nothing can be done to make it easier to live with. Our understanding of pain ( and the methods used to bring it under control) has improved dramatically in recent years.

MANAGING BACK PAIN
Managing back pain does not just mean taking painkillers or undergoing back surgery. There are many other ways in which you can bring your back pain under control and prevent it from recurring.

Adopting simple changes to your lifestyle can bring about immediate improvements in your back pain. These include:

• staying as active as possible
• losing weight (if you are overweight)
• learning how to bend and lift objects properly
• improving your posture (or adjusting your seating position in the car, at work, at the dinner table, in front of the TV, or your sleeping position)

Contrary to popular opinion, bed rest is not recommended for back pain. It is far better that you try to stay as active as possible. Your doctor will be able to advise you which types of exercise are most suitable.

ANALGESIA
Painkillers - or analgesics are drugs that work by interfering with the pain transmission process. Although the stronger analgesivcs are only available by prescription from your doctor, many painkillers that you can obtain over-the-counter from your pharmacist for advice and never exceed the stated dose.

THE DIFFERENT TYPES OF ANALGESIC DRUGS
Drug (Over-the-counter)

• Paracetamol (Calpol, Dispol, Hedex, Panadol)
• Aspirin ( Alka-Seltzer, Anadin, Disprin)
• Ibuprofen (Advil, Cuprofen, Nurofen)
• Compound analgesics:
  - Paracetamol and codeine (Solpadeine Max, Ultramol, Panadol Ultra)
  - Aspirin and codeine (Codis 500)
  -Ibuprofen and codeine (Nurofen Plus,Solpaflex)

Prescription only Medicines

• Aspirin (Caprin)
• Ibuprofen (Arthrofen, Brufen, Ebufac, Motrin)
• Naproxen (Arthroxen,Nycopren, Voltarol)
• Diclofenac sodium (Acoflam, Defenac, Dicloflex, Volraman)
• Compound analgesics:
  - Paracetamol and codeine (Co-codamol, Tylex)
  - Ibuprofen and codeine (Codafen Continus)
  - Aspirin and codeine ( Co-codaprin)

Muscles relaxants:

• Diazepam (Rimapam, Tensium, Valium)
• Baclofen (Baclospas, Lioresal)

Antiepileptic drugs (for neuropathic pain):

• Carbamazepine (Tegretol)
• Gabapentin (Neurontin)
• Pregabalin (Lyrica)

Opioids

• Dihydrocodeine (DF 118 Forte, DHC Continus)
• Buprenorphine (Temgesic, Transtec)
• Diamorphine (heroin)
• Fentanyl (Durogesic, Actiq)
• Morphine (Sevredol, MST Continus, Zomorph)
• Tramadol (Zydol, Zamadol)

Drugs often have more than one name. A generic name, which refers to its active ingredient, and a brand name, which is the registered trade name given to it by the pharmaceutical company. Ibuprofen is a generic name and Nurofen is a brand name.

THE DOS AND DON'TS OF EFFECTIVELY CONTROLLING BACK PAIN

• Don't panic - most spells of back pain will get better
• Don't rest in bed for too long (2-3 days at most)
• Do gradually increase your level of activity
• Do back exercises regularly, perhaps take up a new form of exercise (after checking with your doctor)
• Do contact your doctor if pain persists for more than a week

NON-DRUG TREATMENT
Physiotherapy, osteopathy and chiropractic treaatment are all forms of therapy that involve manipulating parts of the backbone to relieve back pain. Transcutaneous Electrical Nerve Stimulation (TENS) and acupuncture can also offer relief from symptoms. Back surgery is rarely necessary and is usually only undertaken as a last resort.