Most people benefit from self-help, physical and/or psychological therapies when treating a bad back
Four out of five of us will suffer at least one episode of back pain, but many have repeated/chronic pain that can affect work, home and relationships, even though there’s rarely a serious cause.
Our backs consist of bony blocks (vertebrae) cushioned by intervertebral discs, and linked by side/back joints, creating bony tunnels that protect our spinal cords. Strong ligaments and muscles provide stability and flexibility so we can bend and twist. Nerve roots spread out between both sides of each pair of vertebrae, allowing our brains to control our movements and detect sensations.
Misuse or overuse triggers most problems – poor posture (sometimes linked to pregnancy, obesity or a curved spine), prolonged standing, heavy lifting/carrying/manual work, slouching in unsupportive chairs or car seats, bending or overstretching, sudden awkward movements, or overdoing one particular activity.
Inflammation, infection and trauma can damage vertebrae, which may crack because of osteoporosis or secondary cancer spread.
Occasionally back pain is caused by chest or tummy problems, while under-16s often have congenital or growth-related conditions and should always see their GPs.
The severity or site of the pain isn’t always a good guide to what’s wrong; even a minor tweak can be extremely painful.
You may notice pain only on movement or in one position; stiffness, especially in the mornings; pain in a buttock or thigh, or pain, numbness and/or weakness travelling down to the foot if your sciatic nerve is trapped (eg, by a ‘slipped’ disc).
You’ll need blood tests if you have constant pain or night pain lasting six weeks, if pain is linked to weight loss, sweats or other body symptoms, or if you are known to have cancer. And you should seek immediate medical help if pain/numbness affects both legs, or you have trouble urinating or opening your bowels.
You may need an MR (magnetic resonance) scan to show up soft tissues, such as discs and nerve roots; X-rays and CT scans are better at detecting bony or internal causes. But local policies often say only specialists, not GPs, can arrange these.
New guidelines from NICE (National Institute for Health and Care Excellence) list recommended non-surgical treatments (see box, left) and advise when a specialist opinion is needed. They also say epidural injections, radiofrequency denervation (to destroy a painful nerve), and disc or spinal bone surgery can be used if appropriate.
Yoga isn’t included, but new international research says it sometimes helps chronic non-specific low back pain. Pilates can boost muscle strength and flexibility.
NICE also says some traditional treatments should no longer be offered, including corsets, orthotics (shoe inserts/rocker soles), spinal traction, acupuncture, or TENS (transcutaneous electrical nerve stimulation). But if you’ve found that they help you, you could still pay privately for them, if your doctor agrees.
7 Treatments for back pain/Sciatica
1 Ask your GP for advice and information based on your personal needs and abilities (also visit nhs.uk).
2 Continue with normal activities as far as possible. Staying active can help recovery and prevent loss of fitness/mobility.
3 Relieve pain with non-steroidal anti-inflammatory drugs, such as ibuprofen, with or without paracetamol (but check with your pharmacist/doctor first if you have other medical problems or take other medication).
4 Opioids (morphine-related drugs), antidepressant and anticonvulsant drugs should rarely be used.
5 Referral to NHS group exercise program (biomechanical, physiotherapy, aerobic, mind–body or a combination) if this would help you.
6 Cognitive behavioural therapy, especially combined with exercise and physiotherapy.
7 Return-to-work programmes to provide support if your back pain is linked to your employment.