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Low back pain

All of us will experience back pain of one kind or another at some point in our life, but for some of us it can be a persistent, unpleasant and intrusive symptom.

Almost all low back pain is simple, benign, musculoskeletal pain. This doesn’t mean that the pain isn’t significant or distressing. It means that there is no scary disease underlying it that needs urgent action, and instead the way the muscles, spine, connective tissue and nerves are working together is the cause of the pain. If we understand this it then makes sense when we look at the main effective treatments for low back pain.

Exercise and stretching

Poor posture, lack of exercise and loss of muscle tone are common causes of back pain in our modern life where much of our time is spent sitting at work and in the home. As we get older there is a stiffening and weakening of the spinal supports and structures adding to the problem. Specific back strengthening exercises and stretches done regularly can help a great deal, whatever your age and fitness level. There is a great section on back pain detailing some simple exercises at versusarthritis.org. You could also take part in exercise classes that have back strength and flexibility built into them, like Pilates or yoga. Walking and swimming tend to be helpful, and if you are overweight, losing weight can help a lot. If you are struggling though the next step would be to self-refer to a private physiotherapist, or an NHS physiotherapist at plymouthhospitals.nhs.uk/physio-self-referral-form-tavistock. Some people find manipulation helpful with a chiropractor or osteopath but these therapies only tend to be helpful if used in conjunction with exercise and the self-management detailed above.

Painkillers

Paracetamol and ibuprofen can be helpful. Stronger prescription painkillers may be required for short periods but are not a recommended regular treatment for ongoing back pain as the body gets used to them and the painkilling effect wears off - so you get all the side effects and harm but none of the benefits of the tablets. If you are not managing to control the pain with over-the-counter painkillers, it is worth discussing the available options with your GP.

Breaking the negative pain cycle

Pain isn’t a simple thing. There is a cause for pain but the way it impacts on us is changed by many factors – how long the pain has been going on, whether we’re worried it’s something serious like cancer, if we are not sleeping, if we are stressed, if it’s stopping us doing something we love. One of the most powerful pain-busting drugs we have is our mind, and if we can train our mind to dampen down the pain signals rather than boosting them up, we can significantly improve our symptoms.

nhsinform.scot/illnesses-and-conditions/mental-health/mental-health-self-help-guides/chronic-pain-self-help-guide is a useful introduction to this concept but there are lots of books and websites you can access yourself, and some NHS pain courses that specialists refer to. If someone suggests CBT (cognitive behavioural therapy) for your pain, they are absolutely not saying it is all in your head, they are just suggesting a powerful treatment that has been proven to help a lot of people in the same situation.

When to see a GP

Occasionally back pain can be caused by something else that requires different treatment. Your GP will assess you and may well be able to reassure you at that point that there’s nothing serious going on, or they may request blood tests, X-rays (not often used but helpful in some situations) or possibly a scan. As a GP I would like you to contact us if any of the following occurs:

Dr Jo Coldron, Tavyside Health Centre, Tavistock

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