Acute Back Pain
When the medical profession talk about acute back pain they mean
pain in the back which has come on suddenly, may be very painful but,
thankfully, will most often only last for a relatively short time a few
days or weeks. A few unfortunate people will have pain which goes on
longer than this. This is referred to as chronic back pain and this is
covered elsewhere on this site.
In a nutshell
- Back pain is common - over 70% of people will suffer back pain in their lifetime
- Most back pain is not due to serious damage to the back and will get better on its own
- Simple pain relief and remaining active are the best treatment for most back problems
Contents
The Back
The back is a complicated structure made up of many moving parts. It
is central to nearly all of our movements, supports the rest of our
body and carries the spinal cord and its nerves from the brain to the
rest of the body.
The spinal column is made up of 24 vertebrae (the back bones) which
are joined by shock absorbing discs (inter vertebral discs) at the
front and facet joints at the back.
Many muscles and ligaments attach to the bones of the back which allow
the back to support the weight of the body and make all of its
movements.
It is not surprising then, that this complicated structure is prone to
problems (perhaps aggravated by the fact that we as a species have only
recently started walking on our hind legs!). These problems will affect
over 70% of people in the western world during their lifetime.
What is back pain and why do I have it?
As mentioned above, the back is a complicated structure with many
parts; as such it is prone to a number of different problems any of
which may lead to us feeling pain. These problems may involve the
muscles, the ligaments, the discs between the vertebrae, the vertebrae
themselves and in some rare cases the nerves and spinal cord itself.
Types of Back Pain
Lumbago (sometimes called simple or non-specific back pain)
This is by far the most common type of back pain and is pain in the
lower back, often caused by minor injury to the muscles or ligaments of the
back in the same way that you might sprain a wrist or ankle.
Sciatica / "Slipped disc"
This is a pain that although being caused by problems in the back
may only be felt as pain in the legs. It is often caused by irritation
of one of the nerves in the back and may be caused by one of the shock
absorbing discs bulging out and pressing on the nerve.
Arthritis of the facet joints or degeneration of the discs (spondylosis)
This kind of degenerative problem may lead to back pain and may be persistent.
Other rarer causes
Back pain may also rarely be caused by other factors such as inflammation (e.g. Ankylosing Spondylitis), fracture, infection or tumour.
I have back pain what should I do?
The good news is that, for most people, their back problem will get
better within about three weeks! All that is required is some simple pain
relief such as paracetamol, and maintaining your activity as much as
possible.
Although bed rest used to be recommended for bad backs it
has been shown that this makes things worse, as the muscles that
protect your back will get weaker. Bed rest should be avoided if
possible and if your back is really too painful to move, then try to
restrict your bed rest to a couple of days at most!
Should I see my Doctor?
Many people are able to effectively manage their own back pain. Some
people should however get advice from their doctor. If any of the
following apply to you we recommend you seek out your doctor's advice:
- If you are younger than 20 or older than 55 years when you first get the back pain
- If you have recently been involved in a serious accident
- If you have constant pain that is getting worse (particularly if it doesn't feel better with bed rest)
- If you have pain in your upper back (i.e. at the level of your ribs)
- If you have pain moving from your back to your legs
- If you are having problems passing urine, are becoming unsteady or weak in the legs or feel numb
- If you feel generally unwell, have fever or are having night sweats
- If you have been using steroids for a length of time
- If you have a history of Cancer
- If you are immunosupressed, have HIV or have abused drugs
Do I need an X-ray or scan?
Most people with back pain have lumbago or "simple back pain".
For these people an X-ray or scan will not help in the diagnosis or
treatment of their back problem as it is likely to be caused by minor injury
to the soft tissues which will not show up on an X-ray, it may also
show up normal wear and tear to the bones of the back which is not
actually causing the problem, and lead to inappropriate treatment.
In some cases, often where the doctor thinks the pain may be caused by
a trapped nerve or one of the rarer causes of back pain, a CT or MRI
scan may be required to help determine the best treatment for that
patient.
Would an operation help?
For most people there is no operation that will help "cure" your
back pain, as described above the back pain will be caused by a sprain
or strain of the back, for which no operation will help. The few back
conditions which may be helped by an operation of one type or other
will be picked up and assessed by your doctor and if appropriate a
referral to an orthopedic or neuro surgeon will be made. Bear in mind
that only about 1 person in 1000 suffering with back pain will need
back surgery and most of those will be suffering from sciatica and not lumbago or simple back pain
Can anyone else help me?
Many people with acute back pain find that treatment from a
physiotherapist, osteopath or chiropractor helps. In addition to the
physical help they can offer, this group of professionals along with
occupational therapists will be able to offer useful advice regarding
exercises that will help you to strengthen your back and advice on safe
practice of every day tasks that will help you to prevent problems with
your back in the future.
Details of local schemes and therapists may be found here
Common worries and misconceptions of people with back pain
- Is my back pain due to a serious disease?
- I am afraid of injuring myself if I exercise!
- I am unable to do all the things "normal" people do because my back will be too easily injured!
- My body is telling me that there is something dangerously wrong!
- Might the wrong movement cause a serious problem with my back?
- Is avoiding unnecessary movement the safest way to prevent back pain from getting worse?
- Will I become disabled for a long time as a result of back pain?
Is my back pain due to a serious disease?
As mentioned above, the good news is that the
vast majority of back pain is "simple" and although it can be painful
and cause you inconvenience, it is not medically serious and will get
better with time.
If you have any of the features listed above,
then we recommend you see your doctor who will be able to examine you
more carefully and will likely be able to reassure you that there is no
serious problem and/or arrange appropriate treatment.
I am afraid of injuring myself if I exercise!
Activity and exercise are encouraged to help you in your recovery
from back pain. The key is to build up gradually and listen to your
body. Some exercises that may help people with back trouble are
outlined in the Arthritis Research Campaign booklet on back pain.
Advice from a qualified physiotherapist may be very useful in getting you back into active exercise.
I am unable to do all the things "normal" people do because my back will be too easily injured!
It is important to emphasize that back pain is so common that it
could almost be seen as "normal" for people to suffer from it at some
time during their life. As someone who has suffered from back pain, you
will be aware of how important it is to take care of your back, and
hopefully avoid risky actions such as lifting using the back, slouching
or sitting at an incorrectly set up work station.
With the appropriate care (and perhaps by modifying the way you do things) there is no reason that you should find yourself limited in your choice of activities.
My body is telling me that there is something dangerously wrong!
Like an over-sensitive car alarm being set off by a strong gust of
wind, often the pain you feel in your back is likely to be due to the
already injured back over reacting to non-harmful stimuli and not
because there is anything dangerously wrong!
Might the wrong movement cause a serious problem with my back?
Poor posture and incorrect lifting techniques can certainly
contribute to the development of back problems! When you have a bad
back however the pain you feel with certain movements is likely to be
due to aggravation of the now very sensitive back (as described in the
answer to the previous question) and not due to new serious damage
being done to your back.
Is avoiding unnecessary movement the safest way to prevent back pain from getting worse?
Bed rest used to be recommended for the treatment of back
pain, more recently it has been shown that remaining as active as
possible is the best way to recover from back pain.
Will I become disabled for a long time as a result of back pain?
The good news is that the vast majority of people who suffer back
pain recover very well in a few weeks. For those few whose back pain
persists there is more help and advice available which will allow you
to function reasonably normally and avoid disability caused by back
pain. The details of this are described here.
References and further reading
- Arthritis Research Campaign Back Pain Booklet
- Practical, reliable, evidence-based guidance (PRODIGY) Patient Guidance for back pain
- The Back Book. Roland, M.O et al. (2002) The back book. London: Available from The Stationary Office.
Prepared by David Stokes in conjunction with the Department of Rheumatology, Addenbrookes Hospital
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