Back Pain

Back pain is a prevalent and debilitating condition that affects people at some stage during their lifetime, regardless of age or gender. According to the World Health Organization (WHO), back pain is one of the leading causes of disability worldwide.

It is estimated that up to 80% of adults experience back pain at some point in their lives, with approximately 20% of cases becoming chronic or persistent, meaning pain lasting more than three months. Back Pain can impact your quality of life affecting both your physical, mental and social well being.

Low Back Pain

The term back pain covers a spectrum of different types of pain (nociceptive, neuropathic, nociplastic and non-specific pain).

The elements that make up the lumbar spine, like soft-tissue, muscles, ligaments, joints and discs are prone to different stressors, and each alone or in combination can contribute to low back pain. Only a small proportion of people have a well understood pathological cause (e.g.) a vertebral fracture, malignancy, or infection. For most people it is not possible to identify a specific nociceptive cause – they have what is called non-specific low back pain.

Non-specific low back pain refers to pain in the lower part of your back, the lumbosacral area that doesn't have a specific cause but is usually due to ageing, strain or injury to the muscles, ligaments, or joints in your back.

Recommendations for the Management of Low Back Pain

The best practice guidelines for the management of non-specific low back pain, based on international evidence include that:

Low back pain should be managed in the community and not a hospital setting.
The management of low back pain should focus on education and advice.
It is important that people with low back pain are encouraged to remain active and continue to work if possible.
Imaging, such as an MRI scan is only necessary if a specific condition that requires different management to non-specific low back pain is suspected.
The first choice of therapy for managing low back pain should be non-pharmacological.
The use of opioid medication is strongly discouraged

Foster et al., 2018

Considering the best practice guidelines for managing non-specific low back pain,
the following tips may help reduce your backache and speed up your recovery:

Be as active as possible and try to continue your daily activities – this is one of the most important things you can do to self-mange your back pain, as resting for long periods is likely to make the pain worse
Exercises and stretches is the most recommended treatment for back pain; All other activities you enjoy such as walking, swimming, yoga, pilates and golf may also be of benefit in managing your back pain.
Anti-inflammatory painkillers, such as ibuprofen, which are available at your local pharmacy are recommended if required. It is important to check with your GP or pharmacist that the medicine is safe for you to take first.
Some patients find that hot or cold compression packs help for short-term relief.

Best practice pain management is guided by the biopsychosocial model of pain which sees low back pain to be a dynamic interaction between social, psychological, and biological factors.

These factors both predispose to and result from injury, and should be considered when devising your treatment plan.

Early initiation of treatment is important in order to reduce the burden of pain and to support people to remain in employment, continue with social interactions, exercise and everyday activities.

While non-specific low back pain can be uncomfortable and frustrating, most cases improve with time and appropriate management strategies. With the right approach, you can effectively manage your symptoms and get back to doing the things you love. Try and stay positive despite your pain as this can often aid recovery.

Other Causes of Back Pain

Although the majority of low back pain has no identifiable cause, back pain can occasionally be due to a medical condition such as:

a slipped (prolapsed) disc – where a disc of cartilage in the spine presses on a nearby nerve
sciatica – irritation of the nerve that runs from the pelvis to the feet

These conditions tend to cause additional symptoms – such as numbness, weakness or a tingling sensation – and they're treated differently to non-specific back pain.

When To Seek Immediate Medical Attention

Back and leg pain can be severe and really distressing, however as previously outlined, in the majority of cases the pain is not caused by anything serious or dangerous. There are rare cases where symptoms that accompany back and leg pain might need urgent medical attention.

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Cauda
Equina
Syndrome

Cauda equina syndrome is an extremely rare but serious condition where the nerves at the bottom of the back are compressed. These nerves control your legs, bladder, bowel and sexual function and supply sensation to the skin around the bottom, genitals and inner thighs. Cauda Equina Syndrome requires immediate assessment, investigation and treatment.
Without early identification and treatment this condition can lead to permanent damage or disability of your leg, bladder, bowel or sexual function.

If you experience one or more of the signs or symptoms listed below please seek immediate medical assistance by going to your local emergency department:

Loss of feeling, tingling, pins and needles between your inner thighs or your genitals
Numbness in or around your back passage or buttocks
Increasing difficulty passing urine
Increasing difficulty when you try to stop or control your flow of urine
Loss of sensation when passing urine
New onset of leaking urine or needing to use pads
Not knowing if your bladder is either full or empty
Inability to stop a bowel motion or leaking
Loss of sensation with passing a bowel motion
Loss of ability to achieve an erection or ejaculate
Loss of sensation in genitals during sexual intercourse

Other conditions associated with low back pain:

Back pain may need further attention from a medical professional if any of the following signs or symptoms are present:

A worsening of your general health alongside back pain
If you experience significant weight loss that wasn’t planned
If you experience new leg weakness, loss of balance or falls
If you have pain that does not improve with rest and is worse at night

If you are attending our service, and are experiencing any of the above, you can discuss your symptoms or concerns with a member of the team during your assessment.

References ⇣

WHO Guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. (2023)

Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., ... & Woolf, A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383.

Anderson, W. G., Liao, S., Childers, J. W., De Pinto, M., Gordon, D. B., Pirrello, R., ... & Stroud, M. (2021). Improving Pain Management for Hospitalized Medical Patients, A Society of Hospital Medicine Implementation Guide. 2015.

Peter B O’Sullivan, J P Caneiro, Mary O’Keeffe, Anne Smith, Wim Dankaerts, Kjartan Fersum, Kieran O’Sullivan, Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain, Physical Therapy, Volume 98, Issue 5, May 2018, Pages 408–423

Knezevic, N. N., Candido, K. D., Vlaeyen, J. W., Zundert, J. V., & Cohen, S. P. (2021). Low back pain: Epidemiology, mechanisms, and treatment. In Lancet-Seminar Series.

Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., ... & Woolf, A. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367.

NHS National Suspected Cauda Equina Syndrome Pathway

https://gettingitrightfirsttime.co.uk/wp-content/uploads/2023/10/National-Suspected-Cauda-Equina-Pathway-UPDATED-V2-October-2023.pdf