Acute and chronic back pain

Back pain can strike anyone at any age, although studies show people are most vulnerable between the ages of 45 and 59.

If the pain lasts for less than three months, it is called acute back pain, where acute refers to the duration rather than the severity of the symptoms. If the problem goes on for longer, this is known as chronic back pain.

How the back works

The spine is made up of many small bones called vertebrae. These are separated by discs, which allow the spine to bend. This structure of vertebrae and discs is supported along its length by muscles and ligaments. The spinal cord threads through the centre of each vertebra, carrying nerves from the brain to the rest of the body.

Simple back pain

In 95% of cases of back pain, the cause is linked to the way the bones, ligaments and muscles of the back work together. It can come on suddenly but can also be due to strain over time rather than the result of overdoing it just once. Usually nothing abnormal shows up in tests such as X-rays, and generally nothing within the back is permanently damaged.

Most people who suffer from this sort of back pain are adults up to 55 years old who are otherwise healthy. The pain is often based in the lumbar region (lower back), and may also spread to the buttocks and thighs. It will come and go at different times, and depending on different levels of activity.
 
Simple back pain triggers include:
 
 - poor posture, 
 - lack of exercise, 
 - standing or bending down for long periods, 
 - sitting in a chair that doesn’t provide enough back support, 
 - sleeping on a mattress that doesn’t provide enough back support, 
 - lifting, carrying, pushing or pulling loads that are simply too heavy, or going about these tasks in the     wrong way,
 l a trip or fall.

It’s worth bearing in mind that the back is a strong and robust part of the body designed to perform physical work. Being physically active, in itself, is generally good for the back. Indeed, exercise is helpful in speeding recovery from simple back pain.

Nerve root pain

Other causes of back problems are much less common than simple back pain. Nerve root pain is the cause in less than 5% of people. The pain is caused by compression of a nerve root, which is the start of a nerve as it leaves the spinal cord. It is usually caused when a vertebral disc becomes diplaced or bulges out from its normal position, putting pressure on the nerve root. This is called a slipped disc.

The pain will normally be in the lower back, and there may be pain down one or both legs to the calves, feet or toes. In this case, the pain is sometimes called sciatica because the nerve that runs down each leg is called the sciatic nerve.

More serious problems

In a relatively small number of cases, back pain may have a more serious underlying cause. This includes abnormality of the spine, an infection or a collapse of the vertebrae, fibromyalgia (a condition that affects the muscles), tuberculosis or cancer.
These kinds of problem are more likely to be the case if back pain starts gradually, gets worse over time, and seems unrelated to the level of activity.

When to see a doctor

Most attacks of simple back pain last only a few days and get better on their own. But anyone with the following symptoms in addition to back pain should see a doctor as soon as possible:
 
 - fever
 - redness or swelling on the back
 - pain down the legs and below the knees
 - numbness or weakness in one or both legs
 - loss of bladder or bowel control

A doctor should also be consulted if:
 
 - pain lasts longer than a week
 - pain is the result of an injury, a fall or a blow to the back
 - pain lasts for more than a few days in someone aged under 20 or over 55

Diagnosis

In most cases, the doctor will only need to discuss the symptoms and carry out an examination. The doctor is likely to recommend more tests only if the pain lasts longer than six weeks, or if he or she suspects there is some underlying cause of the pain.
These tests might include:
 
 - X-rays
 - CT (computerised tomography) scans
 - MRI (magnetic resonance imaging)
 - A myelogram (a special kind of X-ray using an injected dye) Blood tests

Psychological wellbeing can also play a role in back pain. If the condition is chronic, the doctor may also recommend psychological and social assessment.

Treatment

Stay active

Research shows that bed rest does not help simple back pain – it’s much better to return to normal physical activity as soon as possible. Staying active may hurt more at first, but it helps the back to heal quickly, and reduces the risk of the problem occurring again.
If the pain is so bad that taking to bed really seems the only option, keep bed rest as short as possible before getting up and about again.

Painkillers

Simple analgesics are usually enough to relieve simple back pain. Prescription-only muscle relaxants may help with muscle spasms, but they generally shouldn’t be taken for more than a week as they can cause dependence. A hot water bottle or an ice pack applied to the painful area may offer some relief.

Manipulation and exercise

Back exercises and physiotherapy may be helpful if the pain lasts for a long period of time.

Surgery

If chronic back pain isn’t helped by physiotherapy, exercises or medication, then surgery may solve or help the problem. If the pain is caused by a damaged disc, for instance, this could be surgically removed.

Managing back pain

Good back care can greatly reduce the risk of back pain. To look after your back, make sure you:
 
 l take regular exercise
 l use a chair with a backrest, and sit with your feet flat on the floor or on a foot rest
 l sleep on a firm mattress

 
Lifting and carrying tips:
 
 l Lift only a manageable weight, or ask for help
 l When lifting things or putting things down, bend the knees, and keep the back straight and feet apart
 l Do not lift and twist at the same time
 l Lift and carry objects close to the body.