Back pain is a very common problem. Up to 9 out of 10 people can expect to suffer from back pain or backache at some point in their lives. Out of these, only a proportion of patients seek medical help. Backache often resolve without treatment or with rest. Some patients may ignore the ongoing pain or learn to live with it.

Pain can involve the whole of the back but most commonly it is the lower back which is affected. One of the main reasons for this is that lower back bears more weight of the body compared to the rest of the back and hence, is under more stress during most of the day.

Back pain can be classified according to the duration of pain from which the individual is suffering.

Acute back pain:

This type of back pain lasts about 6-8 weeks. It is characterized by sharp or dull ache which can be easily localized or pointed out by the patient and is usually felt in the lower back. It may be constant or intermittent. The cause is often a recent event or injury and treatment often results in successful recovery.

Chronic back pain:

Chronic back pain is characterized by a duration of more than 2 months. The patient may complain of deep aching, burning or dull pain which may be localized or sometimes also felt spreading down the legs. A tingling sensation or numbness may be felt, suggesting some nerve involvement. It can affect daily activities and tends to be more difficult to treat with standard options.

Back pain may arise from the skin, muscles, nerves, vertebral bones or other organs which are in close proximity to the back. As a result, backache may not always be due to a problem in the back itself. Some possible causes of backache include:

• Poor posture.
• Trauma.
• Muscle strain.
• Muscle spasm.
• Pressure on a nerve root.
• Tears to the ligaments supporting the back.
• Fractures.
• Poor alignment of the vertebrae.
• Arthritis.
• Osteoporosis.
• Viral infections.
• Bacterial infections.
• Skin infections.
• Bladder or kidney infection.
• Gynecological problems in women (Endometriosis, Ovarian cysts).
• Ruptured or herniated vertebral disc.
• Spinal stenosis (narrowing of the spinal canal).
• Spine curvatures (Scoliosis or Kyphosis).
• Tumors of bones.

A good history and a careful examination will often give a good idea of the cause of back pain. Some useful investigations that may also be done where appropriate include:

• Complete blood count.
• X-rays of spine.
• CT scan of spine.
• MRI of spine.
• Bone scan.
• Investigations for other possible causes like tumors and gynecological problems.

The treatment of back pain should be directed at both the pain as well as the underlying cause. Some possible options for treatment of backache include:

• Conservative treatment:

o Complete bed rest which is very helpful in many cases of acute backache.

oStopping strenuous activity which may be causing or aggravating backache.

o Heat therapy.

o Cold therapy.

o Message therapy.

oAnalgesics (painkillers) and anti-inflammatory medications like NSAID’s.

o Muscle relaxants.

o Injections of steroids in severe pain only.

• Lifestyle modification:

o Stop heavy weight lifting or other heavy work.

o Weight reduction.

o Improve standing, sitting and lying postures.

o Avoid long periods of standing.

o Taking breaks during prolonged driving or other sitting activities.

o Use supportive stools and pillows.

o Do relaxing exercises.

o Avoid falls and injuries.

o Avoid rough sports like Soccer, Rugby, Hockey, Wrestling and other physical games.

o Improve back flexibility by regular stretching exercises.

o Physiotherapy and exercises to strengthen the muscles of back.

• Surgical Treatment:

o when conservative methods and lifestyle modifications do not help, surgical options may have to be considered.

Find out how your Back Pain can be more effectively treated.

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