BREAKING THE BACK PAIN CYCLE

A REPORT SPONSORED BY

Back pain – a leading cause of debilitation

Back pain affects around 80% of people(1) at some point in their lives and accounts for

a signifi cant proportion of GPs’ workloads.(2)

During any one year, up to half of the adult population (15%–49%) will experience back pain.(3)

And UK businesses lose around 4.9 million working days a year because of back pain, according

to 2003 fi gures. Back pain affects all industries, not just a few high-risk sectors.(4) The 2003/4

Labour Force Survey shows that the average amount of time taken off in each case of back pain

is 19 days.(5)

Who gets back pain?

There is little difference in the incidence of back pain in men and women, but the number of people

with back pain increases with advancing age, peaking at about age 35–55. In those who continue to

have back pain, it is more likely to be more frequent or constant with increasing age.(6)

What is back pain?

Most back pain occurs in the lower back and is referred to as ‘non-specifi c’ because it is caused

not by serious damage or disease, but by sprains, muscle strains, minor injuries, or a pinched

or irritated nerve. In about 85% of cases sufferers just wake up with back pain and have no idea

what has caused it.(7)

Although it is painful, this type of back pain is not normally serious. In most cases, the pain lasts

from a few days to a few weeks, during which the back will heal itself. Staying active, continuing

normal activity and taking painkillers regularly will normally promote healing. However, in severe

and persistent cases, it is important to seek medical advice so that a correct diagnosis can be

reached and appropriate treatment given.

A person’s spine consists of 24 vertebrae stacked on top of each other. These are separated by

shock-absorbing discs that cushion the bones, allowing the spine to bend. Ligaments hold the

vertebrae and discs together and tendons connect muscles to vertebrae. The spinal cord carries

nerves from the brain to the rest of the body. The spine also contains nerves and muscles.

So why do we experience so much pain and what can we do to reduce our risk of injury?

In the majority of cases, the cause of pain can be linked to the way the bones, muscles and

ligaments in the back work together.(8)

Low back pain

People most commonly experience pain in the lumbar region, right at the bottom of the fl exible

part of the back, just above the pelvis. This is because the lower part of the back bears the entire

weight of the upper body, plus any weight the person is carrying. It also twists and bends more

than the upper part of the back.(8)

The complex structure of the lower back means that quite small amounts of damage to any of the

structures of the back can cause a great deal of pain and discomfort. In some cases, the back

pain can spread to the buttocks and thighs.

Overview

• Back pain is a massive problem in the UK, affecting three-quarters of people at some point in their lives.

• The complex structure of the lower back – where most back pain occurs – means that even small amounts of damage can cause a great deal of pain and discomfort.

• Most back pain is caused not by accidents but by sprains, muscle strains, minor injuries, or a pinched or irritated nerve.

• Immobility related to back pain can exacerbate the problem, sometimes leading people to be caught in a cycle of repeating back pain.

• The best treatment for most back pain is staying active, continuing normal activities and taking anti-infl ammatory painkillers regularly.

• A wide range of painkillers is available but most need to be taken at four-hour intervals.

• A new longer-lasting Ibuprofen is now available from pharmacists, lasting up to eight hours.

Without adequate painkillers, sufferers fi nd it diffi cult to carry on with

normal activities and can get locked into a cycle of worsening pain.

Disc problems

People who have a back problem often talk about having a ‘slipped disc’. But disc problems are

not due to a disc having ‘slipped’. Usually the problem is caused by a disc becoming torn and

distorted and pressing against sensitive nerves from the spinal cord.

Sciatica

Sciatica describes pains running down the leg when the sciatic nerve (which runs from the spinal

cord) has been pinched or irritated by damage to the back.

Diseases that can cause back pain

Some diseases (such as osteoarthritis, infl ammatory joint diseases and osteoporosis) can

contribute to back pain and are likely to need long-term treatment. But they are far less common

than minor damage to the back’s muscles and ligaments.(9)

Back pain: a vicious cycle

Sufferers of back pain can become so debilitated that it affects every part of their lives. Although

in most cases keeping the spine moving is the best treatment, the pain stops them from wanting

to lead an active life, which makes the problem worse.

Movement

Most incidents of back pain don’t last for long and are not due to serious back problems. In the

past, the accepted response to back pain was bed rest. But evidence now shows that rest does

not help recovery – it can actually make the problem worse – so in most cases the advice from

GPs is to keep active.

However, without adequate painkillers, sufferers fi nd it diffi cult to carry on with normal activities

and can get locked into a cycle of worsening pain. Lack of exercise can also lead to weight gain,

which can exacerbate back pain in some individuals and can slow recovery.

Long lasting painkillers, such as the new generation of single dose liquid Ibuprofen, which can

be obtained from a pharmacist, are helpful to break the cycle and enable normal life to continue

while the back recovers and pain eases.(10)

Manipulative treatment can help in some cases. But having a painful back need not necessarily stop

anyone continuing to work. A gradual return to work, with modifi ed tasks, will often help recovery.

Stress

There is a strong connection between stress and back pain. Stress causes a release of stress

hormones and stress hormones increase the perception of pain.(1) Increased pain can, in turn,

lead to increased stress and depression, creating a cycle of depression and pain that can be

diffi cult to break.

Sleep

Back pain can cause a number of sleep problems. Lack of sleep can lead to fatigue and irritability

during the day, which in turn affects well-being; it can also delay the healing process and can

even make a back problem worse.

Painkillers can help relieve symptoms enough to allow undisturbed sleep. The latest generation

of long lasting single dose liquid Ibuprofen lasts up to eight hours, allowing a good night’s rest

without having to wake up to take more painkillers.

Well-being and relationships

Immobility due to pain can lead to a loss of income, diminishment of activities and many other

negative consequences. Back pain has also been linked to stress and depression.(11)

Back pain related depression can also lead to appetite disturbance, decreased energy and

motivation, a lack of well-being and problems with concentration and memory.(12) Chronic low

back pain can interfere with a healthy sex life and lead to relationship problems.(13)

Breaking the cycle

Taking a long lasting painkiller can allow people to sleep, free of pain, at night and carry on with

most of their normal activities during the day, helping to break the back pain cycle.

Painkillers

Most low back pain can be treated without surgery. Treatment involves over-the-counter pain

relief to reduce discomfort and reduce infl ammation that causes pain. The goal of treatment is to

restore proper function and strength to the back, and prevent recurrence of the injury – reducing

pain and allowing the body to heal itself.

If painkillers are needed, it is best to take them regularly.(14) Pharmacists are able to give advice

on the latest remedies available for pain relief, as well as basic advice on back pain.

Deciding which painkillers to use can be confusing. Paracetamol is often suffi cient to tackle

pain if taken regularly at the recommended dose. For an adult, this is 1000 mg (usually two 500

mg tablets), four times a day. However, anti-infl ammatory painkillers are often prescribed as

they reduce the swelling that is associated with sprains and other muscle injuries(15) as well

as tackling the pain. The two types of painkiller can be used together following advice from

the pharmacist.

Anti-infl ammatory painkillers include longer lasting eight-hour Ibuprofen doses now available

from pharmacists, which help relieve pain for a whole working day or night without the need for

further medication. Stronger painkillers are available only on prescription.

A muscle relaxant, such as diazepam, is sometimes prescribed for a few days if the back

muscles become very tense and make the pain worse.

Immobility due to pain can lead to a resulting loss of income,

diminishment of activities, and many other negative consequences.

Osteopathy

Osteopathy is a system of healing that deals with the structure of the body: the joints, ligaments,

tendons, muscles and general connective tissues, and their relationship with one another. It is

based on the principle that structure and function are closely related and that problems with the

structure will cause pain and diffi culty in functioning, possibly in other parts of the body.

Clinical research evidence suggests that osteopathy may be effective in helping low back pain

that started fairly recently (less then three months ago).(16)

Chiropractic

Chiropractors are trained to diagnose and treat disorders of the joints, muscles and ligaments.

They treat all the joints of the body but pay particular attention to the spinal column. Research

has shown that chiropractic treatment can be effective in treating low back pain of recent origin

and may be of help with chronic low back pain.(17)

The Alexander Technique

The Alexander Technique is a way of learning to use the body better by becoming more aware of

balance, posture, and movement. It can help reduce the strain and discomfort that are the result

of poor posture and coordination.(18)

Avoiding back pain

To avoid back pain, it is important to reduce excess stresses and strains on the back and ensure

the back is strong and supple.

Losing excess weight, and taking regular exercise – including strengthening exercises for the

back and stomach muscles – is recommended.

Mattresses should be fi rm and comfortable; and when driving, people should use a seat

(or add cushions) to make sure their back and neck are supported.

Correct lifting techniques should be used when moving items around and, generally, a good

posture should be adopted even when standing or sitting.

Exercises like walking, swimming, yoga and stretching movements are especially good for those

with back pain.

Summary

Most cases of back pain clear up quite quickly and are better treated by ‘carrying on as normal’

than by resting. However, sufferers should always seek medical advice if they are worried.

Pharmacists are now playing an increasingly important part in the self-management process

of back pain and can advise on the latest pain relief, as well as ways to avoid future back pain.

New longer lasting Ibuprofen is now available for up to eight hours’ relief, enabling sufferers to break

the cycle of back pain and manage their condition themselves without the need to visit the GP.

If symptoms do persist for more than 10 days, sufferers should consult their doctor.

1 Big Back Pain – The Stress/Back Pain Connection – www.bigbackpain.com

2 Carolyn Chew-Graham and Carl May – Family Practise (Oxford Journals): 46–49 1999

3 Palmer KT, Walsh Ket al.– Back Pain in Britain (BMJ): 1577–1578, 2000

4 Health & Safety Executive – Back Pain Introduction: www.hse.gov.uk, 2003

5 Michael Millar – www.personneltoday.com (HSE), 2003

6 Burton AK, Balague F et al – European guidelines for prevention in low back pain: ESJ, 2006:15

7 Epidemiology of neck and low back pain. In: Nachemson AL & Jonsson E (eds). Neck and back pain:The scientifi c evidence of causes, diagnosis and treatment. Philadelphia: Lippencott Williams & Wilkins, 2000

8 NHS Direct – Health Encyclopedia – www.nhsdirect.nhs.uk

9 BBC Health Online, 2005 – www.bbc.co.uk/health

10 Patient UK – Low Back Pain in Adults (3,5) www.patient.co.uk

11 Hoogendoorn WE, van Poppel MNM, et al. Systematic review of psychosocial factors at work and in private life as risk factors for back pain. Spine 2000; 25:2114–2125

12 Spine Health – www.spine-health.com/topics/cd/depression/depression01.html

13 Patient UK – Low Back Pain in Adults (3,5) www.patient.co.uk

14 University of Kentucky – Chronic Low Back Pain & How it May Affect Sexuality, 2003

15 University Maryland Medical Centre – www.umm.edu/altmed/ConsDrugs/Ibuprofencd.html

16 Back Care UK – Osteopathy – http://www.backpain.org/pdfs/osteopathy.pdf

17 Back Care UK – http://www.backpain.org/pdfs/chiropractic.pdf

18 Back Care UK – Alexander Technique – http://www.backpain.org/pdfs/alexander-technique.pdf

This report has been written in conjunction with Barrie Savory, Osteopath, Claire Small,

Physiotherapist, and Dr Charles Pither, specialist in psychology of back pain.

Further information:

There is a self-help guide available from NHS Direct at:

http://www.nhsdirect.nhs.uk/help/bodykey/questions/index.aspx?nodes=YPK2zBJ9CdI%3d

Useful websites:

BBC Health: www.bbc.co.uk/health

Patient UK: www.patient.co.uk

NHS Direct: www.nhsdirect.nhs

Medline: www.nlm.nih.gov/medlineplus

The Real Health Institute: www.realhealth.org.uk

Com

plem

entary therapies

References

New longer lasting Ibuprofen is now available for up to eight hours’ relief,

enabling sufferers to break the cycle of back pain and manage their

condition themselves without the need to visit the GP.