WHAT MAKES BACK PAIN EASY OR DIFFICULT TO MANAGE?

The degree to which your back pain impinges on your way of living depends on a number of factors:
- how severe your back pain is
- how long it persists
- how active a life you lead
- how old you are

Mild cases of back pain may mean a couple of days aways from work, or that you miss a couple of activities that you had planned. If the pain resolves itself quickly then things will soon return to normal. However, if back pain is severe and/or persists over a long period of time then it may stop you from carrying out your day-to-day activities, lower your self-confidence, disrupt your sleep and in some cases, cause depression.

For the majority of people (90%), back pain will resolve, largely by itself, within 6weeks or so. Most people (60-70%) end up taking less than a week off work as a result of back pain and 90% of these people are back at work within 2 months. It is when back pain lasts for longer than 3 months that recovery becomes more difficult. In the most extreme cases, some people with chronic pain never return to work.

Considering the potentially devastating impact that back pain can have on our lives, it is vital that we are able to recognise and manage it effectively. However, it is important to remember that back pain management means different things to different people. For most of us, mild pain relief and simple changes to our lifestyles are sufficient to make sure that we are able to cope with our pain and to ensure that it does not return.

WHEN SHOULD I SEEK MEDICAL HELP?
Many people will be able to manage their back pain without requiring medical advice. Although most back pain usually gets better on its own, within a few days or possibly a few weeks, it is important that you do not suffer in silence. If you become worried about your back pain or it does not seem to be getting any better, then you should make an appointment to see your GP.

In particular, you should consult your GP if your pain lasts longer than a week or is as a result 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:

- high temperature
- redness or swelling on the back
- pain down the legs and below the knees
- numbness or weakness in one or both legs
- loss of bladder or bowel control

DIAGNOSING THE CAUSE OF YOUR BACK PAIN
Whilst pain itself does not need to be diagnosed by the doctor, the underlying reasons why we experience back pain may be more difficult to pinpoint.

Pain is very difficult to put into words. In the vast majority of cases, your doctor will try to work out what is wrong with you by asking you to describe what your back pain feels like. It may help you to think about how you would answer the following questions before you visit your doctor.

- Where is your pain?
- Does it stay in the same place?
- What sort pain is it?
- How long does it last for?
- When did your back pain start?
- What were you doing when it started?
- Have you had any back problems in the past?
- Do you have any other symptoms elsewhere in your body?
- Does your back pain restrict your movement?

To understand how severe pain is, doctors sometimes use a scale of zero (none) to ten (severe) or may ask you to classify the pain as mild, moderate, severe or excruciating. It may

also help to use a visual analogue scale to try to verbalise how bad your pain is. These scales are usually with word anchors at each end, such as 'no pain' and 'severe pain'. By marking on the line where you think your pain lies, you are giving your doctor a better idea of its intensity.

For children, drawings of faces in a series - from smiling (none) to frowning and crying (severe) - can be used to determine the severity of pain.

Your doctor may also examine you, and will also refer back to your medical history to work out if there are any other health conditions that might be contributing to your pain. They may also:

• perform a pinprick test to check that your sense of touch is working properly
• test the strength of your muscles by asking you to push against their hands
• test the reflexes in your knees and ankles by gently tapping just below your kneecaps and above yor heels with a special hammer
• perform the 'straight leg test' in which you lie on your back and raise your leg without bending your knee

'RED FLAGS'
There are a number of signs and symptoms that will alert your doctor to a specific cause of pain, so-called 'red flags'. These include:
- your age (if you are younger than 20 or older than 55)
- whether you have sustained a serious injury (eg. road accident)
- pain that is getting worse
- pain in the upper part of your spine
- you have, or have had, cancer
- you are taking steroids
- you have HIV
- you are a recreational drug user
- you have lost a lot of weight
- you are experiencing numbness or significant weakness

Rarely, your GP may be unable to find the cause of the pain and may refer you for further tests (including X-rays, computed tomography(CT) and magnetic resonance imaging (MRI)scans). These tests are not usually painful themselves, and won't take very long to carry out. They will usually take place in a hospital or a specialist pain clinic.

CT and MRI scans
CT and MRI scans are relatively quick and easy ways of obtaining detailed imges of the inside of the body, without needing to perform surgery.

During a CT scan, X-rays are passed through the body at various angles. As they leave the body, the X-rays are detected by a scanner which uses the information to produce a two-dimensional image of the internal structures of the back. CT scanners are increasingly being replaced by MRI scanners, which use radiowaves (which are safer than X-rays) and high-powered magnetic fields to create two-or-three dimensional images. MRI scanners can distinguish between bone and soft tissue and therefore provide a more detailed picture of the inside of the body.

Myelography and discography
Patients undergoing myelography have a coloured dye injected into their spinal canal and are then tipped up and down on an X-ray table whilst radiograhic images are taken. Although these days myelography is not so risky, in the past, some patients experienced arachnoiditis-painful inflammation of the spinal cord after they were injected with the dye.

In discography the dye is injected into the disc that separates one vertebra from the next. This outlines the damaged area of the disc and can help to pinpoint the cause of the pain.

DIAGNOSTIC TESTS USED TO DETERMINE THE CAUSES BACK PAIN
X-ray
Advantages
- can usually rule out any serious diseases.
- shows wear and tear of the spine and broken bones.
- quick and painless.

Disadvantages
- will not show up nerve problems.
- cannot be used alone to determine the cause of pain.
- exposure to too many x-rays can be dangerous.

Blood tests
Advantages
- can be used to determine very specific causes of pain (eg. infection,
tumours,arthritic, diseases).

Disadvantages
- only detect very specific causes of pain.
- resuts must be confirmed by other tests.

CT scan
Advantages
- quick and painless.
- can be used to rule out serious diseases.

Disadvantages
- increasingly replaced by MRI scan
- exposure to too many x-rays can be dangerous

MRI scan
Advantages
- the most advanced type of scan
- quick and painless.
- gives high quality images of bone and surrounding tissues.
- can be used to rule out serious diseases.
- radiowaves are 'safer' than x-rays.

Disadvantagaes
- waiting lists can be long.

Myelography
Advantages
- can pinpoint exact causes of back pain.

Disadvantages
- injection of dye can be uncomfortable.
- more complicated than CT and MRI scans.
- exposure to too many x-rays can be dangerous.
- arachnoiditis (painful inflammation of the spinal cord) is a rare side-effect.

Discography
Advantages
- can pinpoint exact causes of back pain.

Disadvantages
- injection of dye can be uncomfortable.
- more complicated than CT and MRI scans.
- exposure to too many x-rays can be dangerous.

Even after performing these tests,it may still be unclear why you are in pain. This does not mean that nothing can be done to ease the pain and make it easier to live with. Your doctor- in consultation with you will be able to put together a personal pain management plan to help you to control your pain.