Our increasingly sedentary lives are leading to an epidemic of back pain. Dr. Lesley Hickin and Dr Chris Brown explore the causes, prevention and treatment.

Nearly half the adult population in the UK gets back pain lasting at least 24 hours at some time every year. 90% of us are going to have a disabling episode of back pain at some point in our lives. About five million people consult their GP about back pain every year, amounting to around 14 million GP consultations in total. In 1998 the direct health care costs of back pain in the UK were estimated at #1,632 million, of which about #480 million was direct NHS cost, with other costs arising from private treatments such as osteopathy, chiropractic, physiotherapy, and private prescriptions.

What causes back pain?
A highly complicated nervous system governs the function of the back. The spine is made up of 33 small bones (vertebrae) with shock-absorbing discs between them. Muscles and ligaments support this structure, keeping us upright and able to move, walk, run and jump freely.

When the back is damaged it is usually the low back that is most vulnerable to injury. Low back pain is characterised by a number of symptoms, which include pain, muscle tension and spasm or stiffness and is found at any site between the shoulder blades and the folds of the buttocks, with or without spread to the legs (sciatica). Fewer than one in ten people with back pain have a serious condition, and fewer than one in 100 need surgery. Many people worry that they have a slipped disc, which is when one of the discs gets squeezed out between the vertebrae and presses on the spinal cord. The nerves to the legs, bowel and bladder can be affected in these cases. Diseases of the spine such as tumours are very rare causes of back pain.

How long will it last?
Most cases are uncomplicated and last only a few days, but half of all cases last four weeks or more. In most patients the pain will get better of its own accord without any special help. However, back pain can be acute (lasting six weeks or less), sub-acute (six to twelve weeks) or chronic (more than twelve weeks). Many clinical trials have been performed to see what sort of treatment is best in each of these situations.

The Royal College of General Practitioners divides back pain into several types:

• Simple backache is localised to the low back, sacrum, buttocks and thighs. It is most common in those between the ages of 20 and 55.
• Nerve root pain is pain felt down the legs as far as the feet. This is also known as sciatica. As long as it is improving within four to six weeks there is no need for specialist treatment or investigation.
• If there are worrying symptoms such as pain not related to movement or nerve root pain not resolving or other concurrent illness such as cancer or HIV, then specialist referral is necessary. Urgent referral is needed if there is numbness around the bottom area, or trouble passing urine or faeces.

  For most cases of simple back pain no investigations are needed. Your doctor will examine you to make sure there are no worrying signs. Many people expect to have an X-ray of their back, but this is only helpful in a few cases and simply delivers an unnecessary dose of radiation. If needed your GP may perform blood tests or refer you to a hospital where special tests such as MRI scans can be performed.

  What helps?
  Stay active: It has been established that bed rest is not helpful in nearly all types of back pain. It is better to stay as active as possible. It may not be possible to continue working but it has been shown that people who stay immobile take longer to get back to work than those who keep moving.

  Medication: Pain and muscle spasm can be relieved by medication. Anti-inflammatory painkillers such as ibuprofen work best, but paracetamol can also help. If these are not effective your doctor may prescribe other painkillers or muscle relaxants such as diazepam. As the pain eases the level of activity should also increase. Try to go back to work as soon as possible, even if the pain has not completely gone, the longer you are off work the harder it will be to return.

  Exercise therapy: There is strong evidence that exercise therapy may help chronic back pain sufferers to return to normal activities as compared with acute low back pain where exercise therapy has not been shown to help. Multidisciplinary treatment involving education, active exercise programmes, behavioural treatment, relaxation exercises and work-place visits can improve long-term pain and reduce time away from work.

  Many forms of treatment have been tried but controlled clinical trials show limited effectiveness for most of these, compared with the regime described above. Ice, heat, short-wave diathermy and ultrasound are popular, but not proven to be effective. There is weak evidence that acupuncture works, but manipulation can be effective in acute back pain.

  Surgery
  Surgical treatment is only needed in very few cases, and orthopaedic surgeons specialising in back problems may try several other types of treatment before embarking on surgery. Recent developments have meant that damaged discs can be removed by microsurgery, and in some centres the damaged disc can be dissolved away by injection. If you need back surgery, do make sure that your surgeon is experienced in the field and that all the risks and benefits have been explained fully to you.

  The role of work
  Some people are more vulnerable to attacks of back pain than others, for example those who drive a lot, sit answering the phone, work as a cashier, use a computer all day or have a heavy manual job. It is important to maintain a good posture even when seated, and to get up and move around from time to time. Lifting should be done with the legs, not the back, and things should be carried close to the body. Take as much exercise as possible. If the back pain is related to your occupation then discuss this with your employer.

  Help yourself

  • Bed rest does more harm than good.
  • Get moving as soon as possible with the help of medication if required.
  • If you spend all day sitting down get up and move around frequently.
  • Don't slouch on soft furniture.
  • Use a firm mattress in your bed. A board under the mattress can give temporary improvement.
  • Take regular exercise. Walking and swimming are particularly good if you have a history of back problems.
  • If pain persists then seek professional advice.

  Resources
  Backcare
  16 Elmtree Road
  Teddington
  Middlesex TW11 8ST
  Tel: 020 8977 5474
  Visit www.backpain.org

  If you have back pain, you're not alone. Get sympathy and support from fellow iVillagers on the Let's Talk About Health message board.