Back Pain

Back pain, particularly lower back pain (lumbago), is a common condition that affects around a third of the UK population each month. There are many different causes of back pain, and it often goes away without treatment, but it may be a sign of an underlying medical condition. 

Symptoms of back pain include: 

• a dull ache in the lower back
• pain when standing up straight
• reduced ability to move around
• sometimes, stabbing pains that radiate down to the leg or foot

Back pain has many causes. Mechanical back pain is caused by problems with the bones, muscles, ligaments, discs, or nerves in the spine. 

Non-mechanical back pain is caused by an underlying illness or problems with nearby organs such as the kidneys. 

Some common causes of mechanical back pain include:

• muscle strain—this can occur when you damage or strain the muscles in your back due to heavy lifting, awkward movements, poor posture, or strenuous activity. It is normally treated with rest and painkillers. 
• slipped disc —a slipped, or herniated disc occurs when one of the discs that cushion the bones of your spine (vertebrae) bulge out and press on the nerves causing pain. It may also cause pain, numbness, or tingling in the hips, shoulders, neck, and back. A slipped disc is usually treated with rest, gentle exercise, and painkillers, but in some cases may require surgery. 
• sciatica occurs when the sciatic nerve that runs down from your back to your feet is compressed and irritated. It is often caused by a slipped disc. Sciatica normally goes away on its own in around 4 to 6 weeks but may last longer. Treatment for sciatica normally involves taking painkillers and doing special exercises prescribed by a GP or physiotherapist. In severe cases, surgery may be necessary to decompress the disc. 
• ankylosing spondylitis (AS) is a chronic inflammatory condition that causes back pain, joint pain, and fatigue. It can result in the fusing (joining together) of the bones in the spine which can reduce movement and flexibility. The exact cause of AS is not known, but there is thought to be a genetic component. Treatment is normally with a combination of physiotherapy, exercise, and medication.
• arthritis in the spine can damage the cartilage in the lower back causing back pain. This can lead to spinal stenosis, a condition where the spinal column becomes narrowed, putting pressure on the nerves and spinal cord. 
• osteoporosis causes the bones to become thin and fragile and can lead to small fractures in the spine called compression fractures which are extremely painful. 

• some non-mechanical causes of back pain include: 
• kidney stones or infections 
• cancerous or non-cancerous tumours of the spine
• fungal or bacterial infections
• endometriosis —a condition where the womb lining grows outside the womb
• pregnancy —back pain in pregnancy usually resolves after the baby is born
• fibromyalgia —a chronic condition involving muscle pain and fatigue

Most back pain can be treated at home and resolves within a few weeks. If your back pain is mild, some things you can do to treat symptoms yourself include:

• keeping active and continuing with normal daily activities. Avoid staying in bed, or not moving around for long periods
• taking over-the-counter painkillers like ibuprofen helps to reduce inflammation as well as relieving pain. Always read the patient information leaflet and check with your GP or pharmacist before taking any medication 
• if you have pain and swelling, applying an ice pack wrapped in a cloth can help
• if you have joint stiffness and muscle spasms, applying heat such as a hot water bottle can provide relief
• exercise like Pilates, swimming, and yoga is a great way to manage and prevent back pain

If your back pain is getting worse, or not going away with home treatments, make an appointment to see a doctor. You should see a doctor if: 

• Your back pain does not improve after a few weeks
• Your back pain is severe or is getting worse
• You cannot engage in normal daily activities due to back pain

Your doctor may prescribe medications to help with back pain. These may include: 

• non-steroidal anti-inflammatory drugs (NSAIDs) 
• muscle relaxants 
• topical rubs, gels, and creams
• antidepressants like amitriptyline 
• steroid injections 
• stronger painkillers like opioids

Other treatments for back pain include: 

• group exercise sessions
• physiotherapy
• manual therapy to massage and move the muscles, joints, and bones in your back
• cognitive behavioural therapy (CBD) to help you cope with the pain
• for long-term (chronic) back pain, a procedure called a radiofrequency nerve ablation works by sealing off some of the nerves in your back to prevent them from sending pain signals

If back pain is severe, or if other treatments haven’t worked, your doctor may recommend surgery.

An online doctor is a great place to start if you have back pain. Our doctors will ask you about your general health, symptoms, and any other medications you are taking. They can advise on treating your symptoms at home, prescribe or recommend medication to help with back pain, or suggest further investigations if necessary. 

Making an online video appointment is quick and easy at Medicspot. Simply click the link, choose a time and day that suits you, and have your consultation via video link from your phone wherever you are. 

A consultation with one of our NHS-trained GPs costs £59 and appointments are available Monday to Saturday from 9 am to 9 pm.

For mild to moderate back pain, a pharmacist can help. Your pharmacist can recommend over-the-counter medications to relieve back pain and check your medical history to make sure they are safe for you to take. Your pharmacist can also recommend other products to help with back pain such as ice packs, hot water bottles, and topical creams and gels. 

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Back pain is a common, but often troublesome complaint that may impact your day-to-day life or prevent you from doing the things you enjoy. The good news is, there are a wide range of treatments available. If you are experiencing back pain, don’t suffer in silence. Talk to a doctor today about finding a treatment that is right for you. 

References 

NHS: Back Pain June 10th 2022 (Accessed October 12th 2022) 

 PubMed: Diagnosis and treatment of low back pain June 17th 2006 (Accessed October 12th 2022)

Harvard Health Publishing:  If you have low back pain try these steps first April 3rd 2017 (Accessed October 12th 2022)

National Institute for Health and Care Excellence: Back pain – low (without radiculopathy) February 2022 (Accessed October 12th 2022)

NIH. Nationals Institute of Neurological Disorders and Stroke: Lower back pain fact sheet  March 2020 (Accessed October 12th 2022)