Back Pain

According to Health Executive figures (2005/2006) 3.7 million working days a year are lost through episodes of back pain. More than £1 billion of public money is spent by the health service each year on costs relating to back pain, with a further £565 million spent within the private sector (Maniadakis and Gray, 2000). Yet most cases of back pain are non specific.

Back pain can be split into categories; specific back pain and non specific back pain.

Specific Back Pain

This is associated with an underlying health condition or damage to the spine such as sciatica, a slipped/herniated disc and ankylosing spondilitis.

Sciatica – a condition caused by a nerve in the back (the sciatic nerve) being irritated or compressed

Slipped disc – where one of the discs of the spine splits and the gel inside leaks out

Ankylosing spondylitis – a condition where the joints at the base of the spine become inflamed

Non-Specific Back Pain

This condition is where the pain is not caused by serious damage or disease, but by minor injuries or a pinched or irritated nerve. It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle, a minor problem with a disc between two vertebrae, or a small ‘facet’ joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain. This article focuses on non-specific back pain.

What is the Pain?

Unspecific back pain is a very common condition and can affect adults of all ages. Your back is a complex and delicate structure that is made up of a combination of bones, muscles, tendons, ligaments, nerves and joints. Therefore, it does not take a significant injury or damage to disrupt the normal workings of the back and trigger an episode of back pain.

Back pain can be triggered by everyday activities at home and at work, or by poor posture. For example, back pain can occur as a result of bending awkwardly, lifting, carrying, pushing or pulling incorrectly, slouching in chairs, standing or bending down for long periods, twisting, coughing, sneezing, muscle tension, over-stretching, driving in a hunched position, driving for long periods without taking a break, being exposed to prolonged vibration and lack of exercise. You may also experience occasional episodes of back pain as a result of the normal ageing process of the spine, which can temporarily disrupt the normal function of your back. You may sometimes wake up with back pain and have no idea what has caused it.

To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is non-specific back pain which means there is no serious problem or disease of the back or spine.

What are the Symptoms of Non-Specific Low Back Pain?

Although non-specific back pain is sometimes called ‘simple’ back pain, simple does not mean that the pain is mild. The severity of the pain can range from mild to severe. Typically, the pain is in one area of the lower back, but sometimes it spreads to one or both buttocks or thighs. It is often made worse if you move your back, cough, or sneeze. So, non-specific low back pain is ‘mechanical’ in the sense that it varies with posture or activity. Most people with a bout of non-specific low back pain improve quickly, usually within a week or so, sometimes a bit longer. However, once the pain has eased or gone it is common to have further bouts of pain from time to time in the future. Also, it is common to have minor pains ‘on and off’ for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. Back pain can also be classified according to how long the symptoms last i.e. acute back pain – the pain does not last longer than six weeks and chronic back pain – the pain lasts for more than six weeks.

Risk Factors

Risk factors for back pain include:

being 20 to 50 years of age – for reasons that are not fully understood, most cases of backache affect young and middle-aged adults
being overweight or obese – extra body weight places more strain on the bones, muscles and joints of your spine
smoking – it is uncertain as to whether this is a result of tobacco smoke damaging the tissue of the back or due to the fact that smokers tend to have unhealthier lifestyles than non-smokers (or it could possibly be a combination of both)
being pregnant – as with being overweight, the excess weight of carrying your baby can place additional strain on your back
the long-term use of medications that are known to weaken bones, such as corticosteroids
stress – it is thought that people who are under stress may unknowingly tense the muscles in their back, which could trigger an episode of back pain
depression (see below)

Depression does not directly cause back pain but it can be a major contributing factor. Many people with back pain and depression can fall into a vicious cycle. The pain makes them feel depressed, which means that they exercise less and do not take part in everyday activities. The lack of physical activity and exercise means that the symptoms of back pain persist, which in turn makes symptoms of depression worse.

Chronic back pain is less common than acute back pain, but it is still very widespread. In England, chronic back pain is the second most common cause of long-term disability (after arthritis). After stress, it is the leading cause of long-term work-related absence. A recent study found that one in every 10 people reported having some degree of chronic back pain.

The rates of reported cases of back pain in England have doubled over the past 40 years – a trend that is seen in almost all Western nations. There are a number of theories to explain the rise in the number of cases. One theory is that the rates of obesity, depression and stress are now higher than they were in the past. These conditions are all risk factors for chronic back pain. Another theory is that people are now more willing to report symptoms of pain to their GP than they were in the past. It is estimated that one in five people will visit their GP in any given year because of back pain. And 80% of adults will experience at least one episode of back pain at some point in their life.

Outlook

The outlook for back pain can vary considerably between individuals. Some people have minor episodes of acute back pain before making a full recovery. Other people have long periods of mild to moderate back pain that are interrupted by periods of severe pain, which makes them unable to do their normal daily activities.

An Australian study which looked at people who visited their GP because of back pain found that:

40% were completely free of pain within six weeks
58% were pain-free within 12 weeks
73% were pain-free within one year

Psychological and social factors play an important role in the expected outlook for back pain, particularly for chronic back pain. For example, people who have a positive frame of mind and report enjoying a good quality of life tend to make a faster recovery than those who report symptoms of depression and are unhappy with one or more aspects of their life.

Treatment options for back pain include painkillers, spinal manipulation, acupuncture and exercise classes. Some cases of chronic back pain may also benefit from additional psychological treatment for the reasons discussed above.

Information from NHS website and the Register of Exercise Professionals journal.