Management of Lower back pain
Let’s talk about lower back pain
By Dr Brighton Chireka
Back pain is a common problem that affects most of us at some point in our lives. Back pain does bring a lot of fear in some people but the fact is that the majority of lower back pain does not have specific causes , it is non specific. Most cases of this back pain get better on their own and you may not need to see a doctor. Many of us stop going to work when in actual fact we should be going to work when we get this back pain. I hope that this article will help many of us to self manage our back pain and also take action to prevent ourselves from getting it. I will also highlight some serious symptoms that we must not ignore .
Causes of back pain
Our back is made up of bones , muscles, nerves and joints and any problems with these structures will result in pain. It is a relief that most cases of back pain aren’t caused by serious damage or disease but by minor sprains, strains or injuries, or a pinched or irritated nerve.
Non specific back pain can be triggered by everyday activities at home or at work, or can develop gradually, over time. Possible causes of back pain include:
- bending awkwardly or for long periods
- lifting, carrying, pushing or pulling heavy objects
- slouching in chairs
- twisting awkwardly
- Over stretching
- driving or sitting in a hunched position or for long periods without taking a break
- overusing the muscles – for example, during sport or repetitive movements ( repetitive strain injury)
Risk of back pain
Certain things can increase our chances of developing back pain. These include:
- If affected by overweight – the extra weight puts pressure on the spine
- If affected by smoking
- If affected by pregnancy– the extra weight of carrying a baby can place additional strain on the back.
- long-term use of medication known to weaken bones – such as steroids.
- Affected by stress or depression
Symptoms of back pain
Symptoms of non specific lower back pain are mainly pain in the lower back area without any other symptoms. Most people find that movement causes pain and resting relieves the pain. There are some symptoms which should not be ignored so I urge you to see your own doctor without delay if you have back pain and:
- a high temperature (fever)
- Unexplained weight loss
- a swelling or a deformity in the back
- it’s constant and doesn’t ease after lying down
- pain in the chest
- a loss of bladder or bowel control
- an inability to pass urine
- Constant or persisting numbness around genitals, buttocks or back passage
- it’s worse at night
- it started after an accident, such as after a car accident
Diagnosing back pain
Most cases of back pain do not require medical attention and can be treated with over the counter painkillers and self care. Having said that I urge you to visit your doctor if you are worried about your back pain or you are struggling to cope or you have at least one of the above mentioned serious symptoms. Most of the back pain is diagnosed by doctors without needing to carry out tests. Doctors rely on the information that they are given by patients to be able to come up with a correct diagnosis. The General Practitioner (GP) will ask you about your symptoms and then examine your back . You need to prepare yourself as the pain may make you not able to give a clear story about your back pain. Your GP may also ask you about any illnesses or injuries you may have had, as well as the type of work you do and your lifestyle. Some of the questions your GP may ask are :
- When did back pain start?
- Location of pain
- If one had back problems in the past?
- Asked to describe the pain
- medication being used
- What makes the pain better or worse?
- Presence of numbness or pins and needles
- Etc to just mention a few questions one may need to answer.
Be prepared to discuss your ideas about your back pain, concerns and expectations with your doctor and make sure you take ownership of your health. The examination by your doctor will usually assess your ability to sit, stand, walk and lift your legs, as well as testing the range of movement in your back.
If your GP thinks there may be a more serious cause, they will refer you for further tests, such as an X-ray or Magnetic Resonance Imaging (MRI) scan. Otherwise, your GP can advise you about things you can do and treatments that may help reduce your pain and speed up your recovery.
Treatment of back pain.
Treatment for back pain vary depending on how long one has had the pain, how severe it is and one’s individual needs and preferences.
Short-term back pain
We all experience lower back pain and we usually treat it with simple pain killers and do not need to see a doctor . Most people will experience a significant improvement in their symptoms within a period of six weeks.
The following has been found to be helpful in treating lower back pain:
In the past we used to advise people to take bed rest so as to recover from a bad back. This is wrong as we have now found that people who remain active are likely to recover more quickly. We know that it may be difficult at first if the pain is severe , but try to move as soon as you can and aim to do little more each day. You do not harm yourself in most cases if you move around . A few people are so afraid of moving their stiff backs such that they stop moving at all. This is not good as the back pain will not get better and may become a chronic one that will last several months or become permanent. Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.
There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity, and it can distract you from the pain. You can discuss with your employer so that you can either do light duties or altered hours until you are fully recovered.
Use of painkillers
We all use painkillers such as paracetamol and ibuprofen to control the back pain but in most cases we complain that it does not “touch the pain ” at all . I agree that the pain killers may not be strong enough but there are two things that we do which can make it worse. There is need to take these painkillers religiously without waiting for the pain and if there are not taking the pain away we do not stop taking them but we go and see our doctor whilst taking the painkillers. We need to discuss with our doctors about stronger pain killers we can take. We must not forget to keep walking as this will make us get better faster. In addition to strong pain killers our doctors may give us a short course of a muscle relaxant such as diazepam to ease off the spasms in the back. This diazepam must only be taken for a short period of time as it is addictive and one can get hooked on it.
Hot and cold treatments
Some people find that heat – for example, a hot bath or a hot water bottle placed on the affected area helps ease the pain. Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area can also be effective. Don’t put the ice directly on to your skin though, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth before putting it on your skin.
Relax and stay positive
Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition may make things worse. Stay optimistic and recognise that your pain should get better. People who stay positive despite their pain tend to recover quicker.
Change your sleeping position
The way we sleep may be causing us more problems. I advice you to change your sleeping position when in pain so as to take some of the strain off your back and ease the pain. If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing pillows under your knees will help maintain the normal curve of your lower back.
Exercise and lifestyle
Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress. I know certain people wear high heels and look good in them . My suggestions is that do not wear very high heel shoes and if you do wear reasonably high heels , try to wear them for a short time. You can always carry two sets of shoes so that you can wear your flat shoe after the occasion as high heels are not ideal for walking long distances or to be worn for a long time.
Regular exercise and being active on a daily basis will help keep our back strong and healthy. Activities such as walking , swimming and yoga are popular choices. The most important thing is to choose an enjoyable activity that you can benefit from within feeling pain.
Treatment for long-term back pain
Any back pain that lasts for more that 6 weeks is called chronic back pain and need aggressive treatment as it can become permanent and affect your quality of life. Chronic back pain need the help of a health professional and you must continue being active and taking your painkillers.
The following is recommended to deal with this type of back pain:
Exercise classes – group classes supervised by a qualified instructor, where you are taught exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
Manual therapy – therapies including manipulation, mobilisation and massage, usually carried out by chiropractors,osteopaths or physiotherapists.
Acupuncture – a treatment where fine needles are inserted at different points in the body. It’s been shown to help reduce lower back pain.
If the treatments described above are not effective, you may be offered psychological therapy to help you deal with your condition. While the pain in your back is very real, how you think and feel about your condition can make it worse. Therapies such as Cognitive Behavioural a Therapy (CBT) can help you manage your back pain better by changing how you think about your condition.
If you have long-term pain, you may be able to attend a specialist pain clinic. These clinics are available in the UK but doubt if there are available in Zimbabwe.
Surgery for back pain is usually only recommended when all other treatment options have failed or if your back pain is so severe you are unable to sleep or carry out your daily activities.
The type of surgery suitable for you will depend on the type of back pain you have and its cause.
Two procedures sometimes carried out include:
a discectomy – where part of one of the discs between the bones of the spine (the vertebrae) is removed to stop it pressing on nearby nerves . This is done fir prolapsed disc – where one of the disc is pressing on nerves causing pain that goes into legs and foot and is associated with numbness or pins and needles.
spinal fusion – where two or more vertebrae are joined together with a section of bone to stabilise the spine and reduce pain
Please remember that these procedures can help reduce pain caused by compressed nerves in your spine, but they are not always successful and you may still have some back pain afterwards.
As with all types of surgical procedures, these operations also carry a risk of potentially serious complications. In some cases, nerves near the spine can be damaged, resulting in problems such as numbness or weakness in a part of one or both legs or, in rare cases, some degree of paralysis. The best way is prevention so let’s look after our backs .
This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: firstname.lastname@example.org and can read more of his work on his blog atDR CHIREKA’S BLOG
Disclaimer: Some names and identifying details have been changed to protect the privacy of individuals. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.
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