Management of back pain

Back pain is often difficult to pinpoint to a single cause. It may be linked to ageing or degenerative conditions like arthritis, more common in older individuals, which can limit spine movement and lead to pain. However, not everyone with arthritis experiences back problems.

Back pain predictors are often related to other health issues or low fitness levels. Staying active through regular exercise is the best way to prevent back pain. Additionally, there are specific conditions that can cause back pain.

There are certain conditions which do cause back pain. These include:

• Herniated cervical disc (Slipped disc): A condition when a vertebral disc moves out of place or bulges, pressing against nerves or the spinal cord.
• Sciatica: Pain down the leg caused by pressure on a nerve in the spine, often due to a 'slipped disc'.
• Spinal stenosis: Narrowing of the spinal canal, trapping nerves and causing leg weakness or pain.
• Scoliosis: Abnormal sideways curvature of the spine, which can lead to significant back pain if severe.

Non-specific back pain

Non-specific back pain is a type of back pain where, even after imaging (like an MRI scan), the specialist cannot identify a specific cause.

Mechanical low back pain

The second type is mechanical low back pain, which results from the anatomical structures of the back. In most cases, the pain arises from the discs, but it may also involve joints and nerves.

Pathological back pain

The third type of back pain is pathological and occurs less frequently than the first two types. It is caused by primary tumours originating in the spine or secondary tumours resulting from metastasis (tumours spreading into the spine). Fractures due to osteoporosis can also cause this type of back pain.

Back pain can have various underlying causes, and the appropriate specialist depends on the specific issue. For osteoporosis-related back pain, a consultant rheumatologist might be suitable, while an orthopaedic spinal surgeon could help with slipped disc-related pain. Other options include physiotherapists or spinal neurosurgeons.

To determine the right consultant for your condition, you can consult your current specialist or a physiotherapist. If you haven't sought help yet, our dedicated patient advisors can assist you in identifying the right specialist for your back pain treatment.

When you visit our back pain specialists, they will carefully review your medical history and conduct a thorough yet non-invasive physical examination. They will also assess how back pain affects your quality of life, including mood, sleep, and relationships.

Based on the examination and your symptoms, they will form a probable diagnosis, which will be confirmed with further investigations and tests.

X-rays and MRI scans are common diagnostic tests used to identify fractures or tumours. For those with a history of sciatica, an MRI scan is the primary screening tool to visualize soft tissues, discs, joints, bones, fractures, and nerve impingement levels.

Once the cause of the pain is established, your consultant will discuss a personalised treatment plan to manage, improve, or even eliminate your back pain. This plan will be tailored specifically to you and will only be implemented with your agreement.

Your consultant will diagnose your back pain and create a personalised treatment plan. They will explain the treatment options thoroughly, ensuring you understand them before making a decision.

We offer three strategies for relief: short-term, intermediate-term, and long-term management. These approaches include exercises, stretches, coping strategies, medications, and injections to reduce pain and improve your quality of life. Our multidisciplinary approach involves collaborating with physiotherapists to address the issues.

Physiotherapy

For non-specific back pain, your GP or consultant will likely refer you to a physiotherapist first, as it is usually related to mechanical issues like muscle problems or disc wear and tear.

At Sulis Hospital, our chartered physiotherapists offer non-surgical therapies for conditions like sciatica and poor posture. After surgery, consultants may also recommend physiotherapy for rehabilitation.

Successful physiotherapy requires a long-term commitment to lifestyle change. It's not about quick fixes but providing guidance on exercises and ensuring regular practice to improve strength and achieve lasting results.

Pain management

For back pain, the focus is mainly on non-pharmacological treatments like manual therapy with a physiotherapist and exercise. However, if you have neuropathic pains, such as sciatica, anti-neuropathic drugs may be prescribed to help alleviate it.

A combination of medications is often more effective than using a single medication, like using paracetamol alongside ibuprofen anti-inflammatories. Opioids are not recommended, and if you are using them, your consultant will likely encourage you to transition to exercise and coping strategies for pain management.

Steroid injections

The next treatment option for back pain is steroid injections. If over-the-counter painkillers, regular exercise, and stretching do not provide sufficient relief, these injections can be helpful.

For inflammatory back pain, like arthritis, steroid injections can be effective and offer pain relief for six to eight months. Afterwards, the consultant will discuss with the patient any additional treatments that may be beneficial.

Surgery for back pain

Surgery may be considered as a last resort if other treatments like medication and injections have not provided sufficient relief, or if there are significant changes in the spine, such as a slipped disc impinging a nerve or detecting cancer or metastasis.

If the primary cause is degenerated discs with inflammation, spinal fusion may be beneficial. For cases with slipped disc-related nerve impingement and severe sciatica, a discectomy or lumbar decompression is commonly offered.

Surgery for back pain should be approached carefully and only considered once the specialist has identified the root cause of the pain.