03 January 2018
Health statistics show that that one in three adults in the UK will be affected by back pain at some stage in their life.
For some, treatment can be as simple as a course of anti-inflammatory medication, or even a period of rest and gentle exercises, but for others the problem can be debilitating – leading to long-term absence from work, depression or even permanent disability.
But, in the vast majority of cases, the pain can be handled without taking the ‘last resort’ option of spinal surgery.
Dr Abir Doger a Consultant in Anaesthetics and Pain Management at Spire Parkway Hospital explains that patients can get stuck in a Catch 22 situation where the pain prevents effective physiotherapy and the problems simply gets worse.
He explains that interventions and injections can produce very effective pain relief which will then allow the patient to move on to physiotherapy and, hopefully, a return to full or almost full fitness.
Here Dr Doger, who offers a ‘One Stop clinic’ at Spire Parkway, looks at back pain, its causes and its treatments.
1: What is the most common cause?
Actually the most common cause is muscular pain or non-specific back pain. Degenerative spine is the second most common cause.
2: Other major causes?
The other major causes are nerve root compromise (sciatica) and post spinal surgery pain.
3: How long do people tend to suffer before they seek medical help?
This tends to vary significantly; in my experience the patients who could be helped the most are usually the ones who, for professional or lifestyle reasons, delay seeking attention. My priority is to get them back to health as soon as possible so that they can return to their cherished activities.
4: Are there any particular age groups most affected?
Although back and neck pain is more common in older adults, I have successfully treated otherwise very fit and active patients in their twenties and thirties. Unfortunately no-one is immune to developing back problems.
5: What first steps do you take to help you decide treatment options?
Even if your pain issue may seem pretty obvious, which specialists and your own doctor may have seen in the past, I always like to start with a basic history of your health.
I prefer to hear everything you have to say in an unhurried and detailed manner. I would go through each issue in detail and rule out any sinister causes first. These are called "Red Flag Symptoms". Once I am reassured that I have reliably excluded any Red Flag Symptoms I would proceed to physical examination and medication review.
6: What sort of options are available?
The available options depend on the cause of the back pain. The options can be pain relieving medications, injections, TENS therapy (Transcutaneous Electrical Nerve Stimulation) or sometimes even acupuncture can be very beneficial.
7: Once you have managed to relieve the pain what is the next step?
The goal is to recondition the back - which is achieved by very specific and targeted strengthening of the back muscles.
8: Why are targeted injections so efficient?
Injections deliver the therapeutic substances directly to the affected area of the body. This avoids the need to prescribe the patient pain-relieving medications, which usually affect other parts of the body as well.
9: What other interventions are available?
Certain other interventions like spinal cord stimulators, dorsal root stimulators, intrathecal pumps and deep brain stimulation are available but these are usually for complex pain syndromes.
10: Are there many cases when you decide that surgery is the best option?
As mentioned above there are certain “red flag” situations where spinal surgery may be the most suitable option. Having said that, the percentage of patients who go on to need spinal surgery is actually much lower than you might think.