When Backpain strikes

Acute (days to 6 weeks ) back pain affects 3 in 4 Australians badly enough during their lifetime. It hurts, you feel like you cannot move , cannot work and you can feel scared by it. Good news most acute back pains are short lasting (days to weeks) and have simple mechanical origins. Only 5% of all acute back pain has a serious cause, requiring more intensive investigation / treatment. So most back trouble is diagnosed based on you giving a good history and through simple examination. Xrays , CTs are seldom of any benefit. Back pain can be cared for by adjusting activity but remaining as active as possible, avoiding or limiting bed rest, unless spasm is severe. This includes disc prolapse and nerve root pains. You cannot do any damage through normal activities or returning to work early - the opposite is true! You fare better! Take simple painkillers regularly (Paracetamol plus\minus Ibuprofen), if you are fit to do so. Avoid stronger painkillers and diazepam, they are only faintly more effective and have much more side effects. You might need to put up with some pain while you get better. It is debatable whether physical treatments (Physio, Chiro, Osteo) help all people with acute simple low back pain, but they definitely provide some short term comfort and hasten recovery in some. See a doctor if the pain gets worse, persists more than 4 to 6 weeks or you develop worrying symptoms and signs:
- back pain after major trauma
- minor trauma in people with osteoporosis
- history of cancer
- fever , chills and unexplained weight loss
- bacterial infection like urinary tract infection
- intravenous drug abuse
- immune system suppression
- pain worse when on your back, severe night time pain , chest pain
- having a numb bum and pubic area
- recent onset difficulty with bladder and bowel control

How can you help to prevent back pain from recurring, which unfortunately happens in a good proportion of cases. Stop smoking, keep your weight down or loose some , stay physically active (not a doctors joke but all 3 are scientifically proven!!) Any sport will do, but walking, jogging on soft ground, swimming are good activities if you can manage. Watch your posture, check ergonomics at work places, be back wise when lifting, take care when bending, avoid sitting for long periods , especially in cars knees have to be higher than hip , keep a straight and hollow supported back and use a comfortable mattress.

Helko Schenk, Geraldton Medical Group
17 11 2008

Sources:
- John Murtagh, Backache a patient info leaflet
- Egton Medical Information Systems patient info leaflet , 3/2006
- Assessment and Management of Low Back Pain , patient plus article www.patient.co.uk
- Acute Low Back Pain Assessment and Management, Australian Family Physician Vol 33, 6/6/2004