Ask the expert: back pain - should I worry?

Back pain is extremely common. It has been estimated that at least 75% of us will suffer in some degree with back pain at any time in a given year.

There are a multitude of reasons why there is a high prevalence. In part, it may be a reflection of a modern busy lifestyle: stress, inactivity or lack of exercise, unhealthy diet and prolonged sitting etc.

Usually the back pain episode is short lived and settles very quickly, either with activity modification or with the help of ibuprofen (if you are able to tolerate it) and paracetamol.

The majority of back pain can be managed at home without the need to seek professional advice eg reduce or remove the provocative trigger/activity, medication (NSAID eg ibuprofen), hot/warm packs, keep active - albeit at a reduced level. Gone are the days when patients would be admitted in hospital for traction.

There are certain types of back pain that warrant early professional attention. These types of back pain that raise concern have RED FLAG indicators:

1. Age - as a rule, children do not normally complain of continuous back pain. Persistent back pain in under 16 year olds require medical review. Similarly, persistent back pain in people over the age of 60 also requires professional review and a health check
2. Unwell - back pain associated with feeling unwell which may include unintentional weight loss, lack of appetite and not eating, fever and being generally ‘run down'
3. Significant past medical history - malignancies/cancer, tuberculosis, previous spine surgery
4. Trauma - this is worrisome as a fall from a height can potentially cause spine fractures especially if there is a background of osteoporosis
5. Sciatica - persistent leg pain with numbness and weakness. This may be indicative of lumbar disc prolapse or pinched nerve
6. Cauda Equina Syndrome - this is a serious condition where, for example, a large disc prolapse causes so much pressure in the spinal canal and interrupts electrical flow. This can lead to leg paralysis, bladder and bowel dysfunction/incontinence, sexual dysfunction, and profound numbness in the legs and buttocks. Urgent medical review is mandatory including an MRI scan
7. Severe back pain - which is not responding to regular painkillers eg ibuprofen, paracetamol, cocodamol. As a general rule, if back pain is not settling down despite taking painkillers for 72 hours, it is advisable to seek medical review

Comprehensive examination and investigations including blood tests and MRI scans are essential in differentiating “benign“ back pain from more “potential serious“ back  pain, provide reassurance and direct correct treatment.

Caring for your back

Good back care is essential to help avoid many common spinal problems. Here are 10 sensible guidelines, which can be used every day, to help preserve the health of your back:

• Try to alternate between standing and sitting
• Place a support in the small of your back when driving or sitting at a desk
• Exercise by walking or swimming regularly
• Try to lose weight to reduce the load on your spine and back muscles
• Stretch regularly to reduce stiffness and increase mobility
• Watch your posture - try not to slouch or slump
• Be careful when lifting - make sure the load is not too heavy or too large
• Try frequent gentle stretches to reduce the strain on your back
• Keep moving, even if you have an episode of back pain
• Consider whether your bed/mattress is providing the support to your back at night

Mr Ben Okafor FRCS, FRCS (Orth.)
Consultant Orthopaedic and Spine Surgeon

Mr Ben Okafor holds clinics at Spire London East Hospital on Monday afternoons, Thursday afternoons and alternate Wednesday mornings. To book an appointment, please call 020 8709 7817.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.