Managing back pain

Back pain is a common problem that affects 4 out of 5 of us at some point. Back pain can be acute, where the pain starts quickly but then reduces after a few days or weeks, or chronic, where pain might last on and off for several weeks or even months and years. Here are many questions that many patients present with.

What could be causing my back pain?

Back pain is often caused by a simple muscle, tendon, or ligament strain and is not usually a serious problem. Most often, the pain can be due to a range of factors, including poor posture, lack of exercise resulting in stiffening of the spine, and muscle strains or sprains. Apart from the factors listed above, there are also specific conditions that are associated with pain.

What other conditions can cause back pain?

Spondylosis

As we grow older, the discs in the spine become thinner and the spaces between the vertebrae become narrower. Spurs of bone (osteophytes) may form at the edges of the vertebrae and facet joints. This is called spondylosis. All of us will have some of these changes in our spine as we grow older, but they are not painful.

Sciatica

Back pain is sometimes associated with pain in the legs, and there may be numbness or a tingling feeling. This is called sciatica and is caused by irritation or squeezing of one of the spinal nerves (called the sciatic nerve). For most people who develop sciatica, leg pain tends to be the most troublesome symptom and they may not have back pain at all.

Pain travels down the leg because of the irritation of the sciatic nerve in the lumbar spine, but there’s nothing wrong with the leg itself.

In most cases, the reason for the nerve irritation is a bulging disc. Discs are designed to bulge but sometimes a bulge can ‘catch’ on the sciatic nerve roots causing pain that travels all down the leg to the foot. Sciatica is fairly uncommon and fortunately, most people recover quickly, although in some cases it might take many months. About 60 percent of people with sciatica get better within a few weeks to months

Spinal stenosis

Spinal stenosis is back pain associated with pain in the legs which starts after a few minutes walk and tends to get better very quickly when you sit down. This can happen from birth or develop as we get older.

Symptoms often affect both legs but one may be worse than the other. Some people have less discomfort if they walk a little stooped. Like sciatica, the main problem tends to be leg pain more than back pain.

In most cases, neither sciatica nor spinal stenosis is a cause for alarm, but if the symptoms cause you a lot of trouble and greatly affect your quality of life, then you should consult your doctor.

When should I see a doctor about my back pain?

If your pain is very severe or lasts for a long time and if the pain affects your everyday activities.

How can I manage my back pain?

Painkillers

Simple painkillers such as paracetamol may help. You should use them only when you need them, especially when you are having a flare-up of your back pain, but you should not take them more often than every 4 hours up to a maximum of eight tablets in 24 hours.

Non-steroidal anti-inflammatory drugs (NSAIDs)

You can use painkillers and NSAIDs for a short course of treatment of about a week to 10 days. If they have no effect after this time, then they are unlikely to work. However, if they do help but the pain returns when you stop taking them, you can try another short course. You can also try rubbing anti-inflammatory creams or gels on the affected areas.

Exercise

Exercise is the most important way that you can help yourself if you have back pain. Research shows that bed rest for more than a couple of days does not help back pain and in the long-term makes it worse as the muscles in your back become weak and you become less fit.

—Exercise also releases endorphins —your body’s natural painkillers.

—Exercise might make your back feel a bit sore at first but it does not cause any harm.

— Start slowly and gradually increase the amount of exercise you do. You can also try taking some painkillers before the exercises. Over time, your back will get stronger and more flexible and this should reduce pain.

More often, people stop exercising once their back pain has cleared up, but it’s best to keep up with the exercise to maintain strength and fitness as this will help to reduce the chances of your back pain returning. Exercises that may help include Swimming, walking, yoga, and gym exercises.

Posture

Try to maintain good posture when sitting at home, at work, or in the car. Staying in awkward positions for instance while working or driving, will affect the soft tissues in your back and will increase your pain or slow down your recovery.

Lifting correctly

Learning to lift correctly is important to help prevent further episodes of back pain. Avoid heavy lifting if you can. Bend your knees when lifting and allow your spine to move as necessary, without twisting it, try and split loads between both hands and keep the weight close to your body.

Diet and nutrition

There are no special diets that have been shown either to help or prevent back pain. However, if you’re overweight you should consider changing your diet and doing regular exercise to help you lose weight as this will reduce the strain on your back.

Pain management programmes

These programmes may help you control your pain and teach you how to live with chronic pain. They’re usually outpatient sessions and involve learning about the physical and psychological factors that can contribute to pain and what you can do to overcome them.

Dr Otieno is a consultant rheumatologist at Aga Khan University Hospital Nairobi