Dr Victor Mendis Answers The Top 10 Back Pain FAQs
1. What is chronic pain?
Chronic pain is defined as pain that lasts longer than six months. Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating. With chronic pain, signals of pain remain active in the nervous system for months or even years. This can take both a physical and emotional toll on a person.
2. Can you get back pain from stress?
It's generally accepted that emotional stress or psychological factors can make any back pain problem worse; however, the concept of “stress-related” back pain takes this idea one step further. The stress-related back pain diagnosis is a "psychosomatic" or "psycho-physiological" one. A psycho-physiological illness is any illness in which physical symptoms are thought to be the direct result of psychological or emotional factors. This diagnosis means that psychological factors either initiated or are maintaining the back pain, or both. It should be emphasized that even though psychological factors may be causing the physical symptoms, the symptoms are not imaginary. They are very real physical problems (such as back pain), which are being impacted upon by emotional factors.
3. What causes low back pain?
Non-specific low back pain means that the pain is not due to any specific or underlying disease that can be found. It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with 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.
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 nonspecific back pain which means there is no serious problem or disease of the back or spine.
4. I lift a lot of heavy boxes at work, how can I reduce the risk of back pain?
One of the biggest causes of back injury, particularly at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain. You should:
- Think before you lift – can you manage the lift? Are there any handling aids you can use? Where is the load going?
- Start in a good position – your feet should be apart, with one leg slightly forward to maintain balance; when lifting, let your legs take the strain – bend your back, knees and hips slightly, but do not stoop or squat; tighten your stomach muscles to pull your pelvis in; do not straighten your legs before lifting as you may strain your back on the way up.
- Keep the load close to your waist – keep the load close to your body for as long as possible with the heaviest end nearest to you.
- Avoid twisting your back or leaning sideways, particularly when your back is bent – your shoulders should be level and facing in the same direction as your hips; turning by moving your feet is better than lifting and twisting at the same time.
- Keep your head up –once you have the load secure, look ahead, not down at the load.
- Know your limits – there is a big difference between what you can lift and what you can safely lift; if in doubt, get help.
- Push rather than pull – if you have to move a heavy object across the floor, it is better to push it rather than pull it.
- Distribute the weight evenly – if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.
5. When should I see a doctor about my pain?
You should see your doctor as soon as possible. This will enable your doctor to examine you and rule out any serious pathology.
6. Will I need to have any tests?
Usually not. Your doctor will usually be able to diagnose non-specific low back pain from the description of the pain, and by examining you. Therefore, in most cases, no tests are needed. There is no test that can prove or confirm nonspecific low back pain. In fact, some doctors argue that tests can actually do more harm than good when the diagnosis is nonspecific low back pain. For example, the technical jargon used to report on some scans can sometimes sound alarming, when in fact the scan is just showing what would be normal for a given age and not a cause for pain.
Current UK guidelines are clear that routine tests such as X-rays and scans should not be done if the diagnosis is made of nonspecific low back pain.
Tests such as X-rays, scans or blood tests may be advised in certain situations. This is mainly if there are symptoms, or signs during a doctors examination, to suggest that there may be a serious underlying cause for the back pain.Magnetic Resonance Imaging Scans (MRI scans) give a very clear picture of the structure of the spine. It does not tell the doctor why the spine is painful. In 85% of patients we are unable to say why back pain occurs. It is often more useful to concentrate on getting back to normal activities and taking good pain killers to get better quicker. Scans are very helpful in serious spinal disorders such as cancer, infection or nerve compression. There are useful clear guidelines about serious symptoms or 'Red flags' that help determine if a scan is required. Previous histories of cancer surgery, weight loss, or weakness in a limb are some of the 'red flags'. A common problem for spine surgeons is that of 'mixed messages'. Patients can sometimes be quite worried by 'dramatic' descriptions of what scans show. A loss of water content in a disc makes it look darker than others. This can be normal. It can be described as 'degenerative discs' a term that might cause concern, but if it was described as 'a bit like getting grey hair' that would be less frightening. Normal discs will 'bulge', and this is not the same as a disc 'prolapse'. A disc prolapse can sometimes be entirely pain free, but will sometimes cause symptoms. A health care professional who deals with spinal disorders should be comfortable with advising if a scan is required and interpreting your scan in clinical context. They should be able to show you the pictures and explain them to you.
7. I’m nervous with injections; can you treat back pain without a procedure?
Treatments for back pain vary depending on how long you have had the pain, how severe it is, and your individual needs and preferences. There are a wide variety of non-surgical options for back pain treatment of the lumbar spine. The more common treatment approaches include:
- Pain Medication. Typical pain medications used to treat the lower back pain include acetaminophen, NSAIDs, oral steroids, narcotic drugs, muscle relaxants and anti-depressants. Each type of medication has strengths, limitations, and risks, and the patient’s particular problem in the lower back and overall health will determine which pain reliever, if any, is indicated.
- Heat or ice. Application of a cold pack or heating pad can help relieve low back pain. Some people find that alternating between the two works best.
- Manual manipulation. This treatment may be applied by a chiropractor, osteopathic doctor, or other qualified health professional. It is thought to help relievelower back pain by reducing pressure on sensitive structures, increasing flexibility, improving blood flow and reducing muscle tension. Therapeutic massage. Massage therapy is thought to improve blood flow, reducing muscle stiffness, and decrease stiffness.
- Exercise. A program of back exercises and physical therapy will usually include a combination of strengthening, stretching, and low-impact aerobic exercise.
8. Once I’ve had treatment, will the pain come back?
Pain is a chronic recurrent disease and therefore it can recur. However if you are pain free after the initial treatment then you should increase your activity levels, strengthen your muscles and this would hopefully prolong the effects of treatment.
9. Will I be awake when I have my injection and will it hurt?
Injections are performed under sedation (sometimes very heavy) and/or with local anaesthetic. Patients usually do not recall the procedure at all with sedation. A full general anaesthetic is not necessary for injections. Some patients do opt for only local anaesthetic.
10. Once I’ve had my injection, will I be pain free?
Injections are performed for various reasons; therapeutic-to give you relief, diagnostic-to identify the pain generator and prognostic-to decide on further treatment modalities. Sometimes your consultant may recommend more definitive procedures following a diagnostic block.
Dr Victor Mendis, Pain Managament Consultant.
Clinics: Tuesday mornings. For more information or to book an appointment, please call 01245 253760 or e-mail email@example.com.