Back pain - the facts

Our increasingly sedentary lives are leading to an epidemic of back pain. Dr. Lesley Hickin and Dr Chris Brown explore the causes, prevention and treatment.

Nearly half the adult population in the UK gets back pain lasting at least 24 hours at some time every year. 90% of us are going to have a disabling episode of back pain at some point in our lives. About five million people consult their GP about back pain every year, amounting to around 14 million GP consultations in total. In 1998 the direct health care costs of back pain in the UK were estimated at #1,632 million, of which about #480 million was direct NHS cost, with other costs arising from private treatments such as osteopathy, chiropractic, physiotherapy, and private prescriptions.

What causes back pain?
A highly complicated nervous system governs the function of the back. The spine is made up of 33 small bones (vertebrae) with shock-absorbing discs between them. Muscles and ligaments support this structure, keeping us upright and able to move, walk, run and jump freely.

When the back is damaged it is usually the low back that is most vulnerable to injury. Low back pain is characterised by a number of symptoms, which include pain, muscle tension and spasm or stiffness and is found at any site between the shoulder blades and the folds of the buttocks, with or without spread to the legs (sciatica). Fewer than one in ten people with back pain have a serious condition, and fewer than one in 100 need surgery. Many people worry that they have a slipped disc, which is when one of the discs gets squeezed out between the vertebrae and presses on the spinal cord. The nerves to the legs, bowel and bladder can be affected in these cases. Diseases of the spine such as tumours are very rare causes of back pain.

How long will it last?
Most cases are uncomplicated and last only a few days, but half of all cases last four weeks or more. In most patients the pain will get better of its own accord without any special help. However, back pain can be acute (lasting six weeks or less), sub-acute (six to twelve weeks) or chronic (more than twelve weeks). Many clinical trials have been performed to see what sort of treatment is best in each of these situations.

The Royal College of General Practitioners divides back pain into several types:Simple backache is localised to the low back, sacrum, buttocks and thighs. It is most common in those between the ages of 20 and 55. Nerve root pain is pain felt down the legs as far as the feet. This is also known as sciatica. As long as it is improving within four to six weeks there is no need for specialist treatment or investigation. If there are worrying symptoms such as pain not related to movement or nerve root pain not resolving or other concurrent illness such as cancer or HIV, then specialist referral is necessary. Urgent referral is needed if there is numbness around the bottom area, or trouble passing urine or faeces.