Back Pain

What is causing my back pain?

The vast majority of a patient’s symptoms are from mechanical back pain that will resolve within a few weeks of onset with appropriate conservative treatments.

In about 85% of back pain sufferers, no clear cause can be identified.

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The following factors could contribute to back pain:

• Having a past history of back pain, smoking or obesity. 

• Physical factors such as heavy manual work, frequent bending, twisting, lifting, pulling and pushing, repetitive work, static postures and vibrations. 

• Psychosocial factors such as stress, anxiety, depression, job satisfaction, mental stress.

Could it be something serious?

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Occasionally back pain can be due to a serious underlying problem such as infection, tumours or fractures. Patients may present with ‘non mechanical’ back pain whereby the pain is constant and unrelated to increased activity. "Red Flag" signs are used to help identify people who may have one of these causes for their back pain. These Red Flag Signs include:

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• Non mechanical back pain

• Age under 20 years or over 50 years

• Bowel or bladder incontinence/retention

• Fevers, rigors, night sweats

• Past medical history of trauma, cancer, steroid exposure, IV drug abuse, anticoagulation (eg Warfarin)

• Progressive numbness or weakness

• Unexplained weight loss

• Pain that wakes you from sleep

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If you have any concerning symptoms, then you should seek professional medical advice.

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When should I see a spinal surgeon?

Most lumbar back pain will improve within a 2-3 month period with physical therapy, exercise and activity modification along with back care education.  However, if symptoms persist or if there are any "Red Flag" signs, then a specialist review and investigation may be required.  

Comprehensive history, examination and investigations including MRI scans are invaluable in differentiating between benign back pain and more sinister causes of back pain, with the aim of providing reassurance and to help implement the correct course of treatment. 

What treatments are there for back pain?

The type of treatment depends on the severity and duration of the symptoms as well as the underlying cause. Treatment options fall into three main categories.

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1. Conservative - Physical or manual therapy guided by physiotherapists, osteopaths, chiropracters and sports masseurs.  Painkillers, heat application, activity modification and even short term muscle relaxants can often help.  Click here for further material.

2. Injections - Steroid injections around facet joints, epidural injections or injections around the nerve root are powerful tools.  Radiofrequency denervation aims to numb painful joints in the spine.

3. Surgery - This is rarely required or indicated for back pain and should remain the option of last resort following the exhaustion of all conservative measures.  I will always provide an open and honest discussion about the benefits and risks of the different surgical options.