By Mr Caspar Aylott
B.Eng(Hons) MBChB FRCS (Tr and Orth) Doctor of Medicine
Consultant Spine Surgeon at The Cheltenham Spine Clinic
Published in Cotswold Life October 2018 p 208-209
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Why do I get back pain?
Back pain is common, affects 25% of the population at any one time, 85% of us will experience back pain during our lives and is the most common reason for time off work. The spine is an individually unique and complicated structure made up many small facet joints, intervertebral discs, ligaments and muscles, any of which can be a pain source. Age related changes similar to ‘going grey’ occur in our back as we get older which typically affect first the discs and subsequently the facet joints. For the most part these normal ‘wear and tear‘ changes do not cause symptoms however episodes of back pain can occur with or without a specific event or trigger. Inflammatory processes can become established leading to back pain and stiffness. Symptoms typically wax and wane over days, weeks or months and this pattern can help an expert determine where the pain is arising from. Psychological and social factors may influence how well an individual copes with and recovers from an episode.
Could my back pain be serious?
It is very unlikely that your back pain is caused by a ‘serious spinal problem‘. However, when back pain is accompanied by feeling unwell, weight loss, night pain, sweats, neurological symptoms affecting both arms or legs, bladder or bowel disturbance, recent history of cancer, you should see your GP or a Specialist.
I’ve tried everything but my back pain is ongoing and making life miserable?
Many of the individuals I see have had back symptoms for years. They have typically consulted a range of different practitioners including physiotherapists, osteopaths, chiropracters, GPs and others. Almost everyone seems willing to give an opinion on back pain because it is common. Too many people receive ‘mixed messages‘ about what is wrong with their back and what they can and cannot do. Much of this is good intentioned advice but can also be based on speculation not backed up by appropriate experience, investigation or imaging.
So what should I do if I have back pain?
Good quality conservative management settles most episodes of back pain. Try taking an anti-inflammatory painkiller (such as neurofen or discuss with pharmacist) continuously and maximally if tolerated (beware stomach irritation) over one to two weeks. They are less effective if taken intermittently. Try to keep moving during the episode avoiding prolonged periods of lying or sitting such as in the car, or a particular activity which provokes your symptoms. Good quality physiotherapy will work on gentle stretching, flexibility, and strengthening of the back and abdominal muscles. Chiropractic and Osteopathic treatment is popular and effective in some individuals but this does depend on the underlying problem. Accupuncture, Pilates, Yoga and massage can also be effective.
The pain in my back also radiates down the leg. What is this?
If a nerve gets pinched in the back this can cause pain, pin and needles, and numbness, radiating down the leg. This is called sciatica and is most commonly caused by a ‘slipped disc’ or arthritic spinal joints pressing on a nerve. If symptoms persist after six weeks of conservative management as described above then see a spinal surgeon. I regularly see patients who put up with sciatic symptoms for years, that are clearly not responding to conservative therapies such as physiotherapy or chiropractic treatment. Sciatica is a common and very treatable problem.
Why see a spinal surgeon?
Too many people put up with back symptoms for too long without attempting to find out what is actually wrong. If you have intrusive back or leg symptoms that are not responding to conservative treatments then it may be worth seeing a spinal surgeon. This does not mean you require or will be offered surgery – in fact I offer this in less than 10% of people I see. The aim of this appointment is to make a thorough assessment of the spine and if possible reach a diagnosis. Xrays and MRI scans may be organised to obtain as much information about the spine as possible. Imaging should only be organised by the specialist who has the experience and knowledge to discuss the relevance of these findings and present up to date treatment options.
What interventional treatments are available?
This largely depends on whether the problem causing the pain can be localised. Targeted cortisone injections (like one may have in the knee or hip) are simple and safe and can be very effective at settling an episode of pain and may help direct other treatments. Percutaneous denervation can abolish pain from the facet joints. Soft cushions can be placed at the back of the spine to support a level. Disc replacements work well especially in the neck and preserve movement. Minimally invasive and novel techniques are now possible to fuse (stop moving) a painful unstable segment.
What should I expect from seeing a Specialist?
By seeing a specialist you have ensured that everything that can be done has been done. You will have a greater understanding of what is actually going on in your back based on objective findings and any ‘mixed messages’ or ‘myths’ addressed. We know from good quality studies that patients who understand their back do better. A clear diagnosis helps direct further management (whether conservative or surgical) and predict future outcomes.