Back pain in the vast majority of patients is pain in the lower back and around 50% of the population at some time in their life will suffer. You can have pain elsewhere in the back such as the thoracic spine or neck and there are a large range of causes for these different pains. However, the vast majority of individuals will suffer with that lower back pain where the biomechanical forces are really focused on the lower back as it supports everything above it day in day out.
What is the prognosis with back pain?
The vast majority of patients who suffer with back pain will see this improve in weeks or months. Beyond that, it is very important that we as doctors try to break that cycle of pain and prevent it from becoming chronic pain. A small number of patients will see their back pain persist and it can become a lifelong limiting factor in their function. That’s where the the role of the pain physician subsequently becomes very important.
What is chronic back pain?
Chronic back pain is a situation that we try to avoid getting into because it can be a vicious cycle that is very difficult for the patient get out of. The mainstay treatments of analgesia or physiotherapy are very important. There is rarely a surgical target that can make the pain better but injection therapy is an option. In this scenario, management by a pain physician is very important as there are multiple different approaches.
What are the non surgical treatment options for back pain?
Analgesia is very important for back pain – simple medications from paracetamol, codeine and anti-inflammatories. Physiotherapy is also very important for lower back pain and has level one evidence to support its effect, at the time of the back pain but also for the future. It works on appropriate postures and improving the core stability of the lower back muscles.
Managing back pain with physiotherapy
Physiotherapy is extremely important for the management of back problems, be it sciatica or back pain. Physiotherapy has a variety of roles but the core stability exercises are very important as this improves the tone in the musculature at the lower back. As these muscles take so much biomechanical force every minute of the day and through every position that we put it through by our adjustments millions of times a day, it’s very important that those muscles are strong. You’re trying to break the cycle where back spasm occurs which can be very painful.
How is chronic back pain treated?
We begin with minimally invasive or non-invasive options such as analgesia and physiotherapy. Beyond that there is the option of injection therapy for a small number of patients who may have a specific abnormality in the spine such as a slip of one vertebrae on another – something called spondylolisthesis. This can also be targeted by surgery as a last resort.
Do injections for back pain cure the problem?
Steroid injections are really there to help through the symptoms, rather than cure pain. However, if a patient is worried about the getting into a position which causes spasm, steroid injections can be very helpful as they will at least temporarily break the pain cycle and allow for physiotherapy and more function day-in day-out. One would hope that would reduce the the back pain over a period so although injections don’t structurally change anything, they do provide an opportunity for respite and for the back to recover and allow physiotherapy and other treatments to have an effect.