Back pain

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The information below has been written for people with back pain. It provides general information about back pain and what can be done to help it. It also tells you where to find further information. This sheet is not meant for people with back pain from osteoporosis.

What is back pain?
Back pain is pain that is felt in the lower part of the spine. It is a sign that the joints, muscles or other parts of the back are injured, strained or not working properly. Back pain is very common with four out of five people experiencing it at some time in their lives. Most bouts of back pain get better in several weeks with little treatment.

What are the symptoms?
Back pain can be felt in the back, as a sharp pain, ache or spasm. It can be felt in the middle of the back or on either side. Your back may feel stiff, making it difficult to turn or bend in certain directions. Sometimes pain can be felt in one or both of the legs, too. This can be a symptom of sciatica, a condition affecting the sciatic nerve. This nerve runs from the spine all the way down the leg.

What causes it?
There are many joints, muscles and other structures in the back that can cause pain. In most cases it is not even possible to find a cause of the pain. It can be worrying not knowing exactly what is wrong. The good news is that research shows you do not need to know the exact cause of the pain to be able to deal with it successfully. It is rare for back pain to be caused by a serious medical problem.

Should I see a doctor? You should talk to your doctor or other health professional if your pain is bothering you. They will ask you about your symptoms and examine you. In most cases tests such as x-rays and blood tests are not helpful in finding out the cause of back pain unless there has been an obvious injury or strain. They may check for any serious medical problems that could be causing your pain, but these are rare. You should see your doctor if:

• your pain does not settle down after a few weeks, or starts getting worse
• you have symptoms such as losing weight, tingling or numbness in the legs or feet, sweats and chills, problems controlling your bladder or bowel
• you have osteoporosis and you start getting back pain.

What will happen to me?
For most people back pain settles down fairly quickly. This usually takes several weeks but can be different for different people. After two months, nine out of 10 people will have recovered from back pain. About half of the people who get back pain will have it again within a couple of years. Between attacks most people return to normal activities with very few symptoms. It is important to learn ways to prevent another bout of back pain. See your doctor or physiotherapist for advice.

What can I do?
Talk to your healthcare team.
It is normail to worry about the cause of your pain and how it will affect you.Talking to your doctor or other health professional about your worries can be helpful. You will usually find there is no serious cause and there are ways you can deal with it.

Learn about back pain and play an active role in your treatment. Not all information you read or hear about is trustworthy so always talk to your doctor or healthcare team about treatments you are thinking about trying. Reliable sources of further information are also listed in the section below. Self management courses aim to help you develop skills to be actively involved in your healthcare. Contact your local Arthritis Office for details of these courses.

Learn ways to manage pain. Talk to your healhthcare team about ways to relieve your pain. Massage and acupuncture have been proven to help with longerterm back pain. There are also medicines that can help with back pain. Some herbal medicines (such as Devils Claw, Willow Bark and Cayenne) may help to relieve pain. However these have only been tested in short-term (6 week) studies. Always talk to your doctor or pharmacist about your medicines, as even natural and over-the-counter medicines can have side effects. See the Medicines and arthritis, Dealing with pain and Complementary therapies information sheets.

Stay active. Your back is designed for movement. The sooner you get back to your normal activities the sooner you will recover from a bout of back pain. You may need to rest or reduce some activities when the pain is bad. But resting for more than a day or two usually does not help and may do more harm than good. See a physiotherapist or other health professional for advice about exercises to keep your back moving. See the Working with your healthcare team information sheet for more information about seeing a physiotherapist.

Acknowledge your feelings and seek support. It isnatural to feel scared, frustrated, sad and sometimes angry when you have pain. Be aware of these feelings and get help if they start affecting your daily life. See the Arthritis and emotions information sheet. There are many other treatments for back pain that have not been well proven. If a treatment has not been proven, it does not necessarily mean it will not help you. It may mean that more research is needed. These treatments include:

• manipulation of the spine
• herbal medicines
• transcutaneous electrical nerve stimulation (TENS)
• low level laser therapy
• heat and cold (eg. hot water bottles, heat packs, ice packs).

Your healthcare team can give you more advice and information about whether any of these or other treatments might be useful for you. Or see the Dealing with pain information sheet. Traction has been proven not to be useful for back pain.

Back pain is common but is rarely due to serious disease. Staying active will help you get better faster and prevent more problems.

For more information:

Books
Dunkin, Mary Anne 2002, All you need to know about back pain, Arthritis Foundation of America, Atlanta, GA.
Tanner, John 2003, Better back: A self help guide to preventing and treating back pain with orthodox and complementary medicine, Dorling Kindersley, London.
Lam, Paul 2004, Tai chi for back pain: Also for wheelchair bound and other chronic conditions, Tai Chi Productions, Narwee, NSW. [DVD or video] Weiner, Debra K & Mitchell, Deborah 2007, What your doctor may not tell you about back pain: The 6 step program for lasting relief, Warner Wellness, New York NY.

Websites
The Arthritis Research Campaign www.arc.org.uk
American College of Rheumatology www.rheumatology.org
The National Health and Medical Research Council (NHMRC) has an information sheet on acute back pain available at www.nhmrc.gov.au
The Australian Physiotherapy Association can help you ‘find a physio’ at www.physiotherapy.asn.au