About back pain

Many people suffer from back pain. It is just as common in men as it is in women and can affect young and old alike. There are different ways to treat back pain and the first step is to identify whether the pain is simple, acute back pain or chronic back pain. In nearly all cases, back pain can be successfully treated without the need for surgery.

How the back works

The spinal cord is the central nervous system of the body, sending messages to the brain. The spine, made up of circular shaped bones called vertebrae, protects the spinal cord. The nerve roots of the spinal cord come out between each vertebra and a rubbery 'disc' in between each vertebra cushions the bones. The discs allow the spine to flex and ligaments connecting the vertebrae give the spine strength and movement. Muscles are attached to the spine and support the back.

Simple back pain

Simple back pain is the most common type of back pain. It is called simple back pain because there is no underlying disease causing the pain. Almost all cases of acute back pain are classed as simple back pain.

Acute back pain

Acute back pain can be caused by a muscle injury or sprain, or a minor problem with the discs or joints. Acute back pain may be sharp, stabbing, or aching. It usually centres around one area of the back, however it may affect the neck, buttocks, shoulders and thighs. The pain is usually continuous and ranges in severity. Mechanical back pain is another form of acute back pain. Pain is experienced when coughing, sneezing or from any movement or activity. Treatment for acute back pain can involve taking painkillers, rest, and a general continuation of every day activity. Physiotherapy can also successfully relieve pain in the short term. Acute pain usually subsides after six to eight weeks.

Chronic back pain

If the pain continues longer than three months it is generally considered to be chronic back pain. This pain can feel like a deep ache and sufferers may have pain for months, and even years. Chronic back pain may cause numbness, tingling or burning and sometimes pins and needles in the legs. Treatment for chronic back pain differs from acute back pain because sufferers may find it difficult to continue every day activities. Chronic back pain can also be caused by an old previously healed injury, or ongoing problems such a nerve damage or arthritis.

Investigations

Physiotherapy, consultation with an Orthopaedic surgeon and MRI scan.

Treatment

Most back pain can be treated non-surgically, and your consultant will talk through the treatment options available during your consultation.

Non-surgical treatments include:

Injections for back pain relief

You may be offered immediate pain relief or treatment in the form of an injection. You may be able to receive these on the same day as your consultation, or you can make an appointment for another day soon after. Two types of injection are offered for back pain relief, and these are outlined below:

• Caudal epidural - for leg or sciatic symptoms.
• Trigger point injections - for local areas of spinal or paraspinal pain.

Physiotherapy

Your back pain may benefit from a course of physiotherapy. Your consultant will discuss a treatment plan with you.

Surgical procedures:

Discectomy

This operation involves removal of part of the intervertebral disc and can be done by a variety of techniques including open incision, microdiscectomy (which may allow a smaller incision, as the surgeon uses an operating microscope) keyhole or endoscopic techniques.

Decompression

This involves removing any tissue that is compressing the nerve.

Stabilisation/Fusion

This is a more extensive surgery where two or more adjacent vertebrae are fixed together, either rigidly or flexibly, to try and give the spine more stability. Your surgeon will explain which technique is most appropriate for you.

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