• Reference Number: HEY1136/2020
• Departments: Emergency Department, Physiotherapy
• Last Updated: 31 October 2019

Introduction

This leaflet has been produced to give you general information.  Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Back Pain

Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden sharp pain.  In some cases back pain can spread to the buttocks and thighs and cause pain down one or both legs.

In most cases people with back pain recover quickly and many do so without treatment.  Some people experience repeat episodes which can be distressing but again these are rarely serious.

Why have I got back pain?

The complex structure of your lower back means that even a mild sprain to any of the structures of the back can cause a lot of pain and discomfort. The spine is one of the strongest structures in the body and in time this pain will improve.

Many factors can contribute to the amount of back pain that you experience and how long it persists. There may be a combination of factors including:

• Physical – such as ‘protecting’ the back and avoiding movements
• Psychological – including a fear of damage or not getting better, feeling down or being stressed
• General health and lifestyle – like being tired and run down, being overweight and not getting enough physical activity
• Social triggers such as difficult relationships at home or work, low job satisfaction or stressful life events like a family death or illness

Each of the factors above can increase your feeling of pain but gaining a greater understanding of these puts you in a better position to recognise them and learn how to control and reduce the pain you are experiencing.

How is it diagnosed?

In most cases, an X-ray or scan is not required to diagnose your back pain.  Normal age related degenerative changes which would be picked up on an X-ray or scan can cause people to avoid movement and exercise which they should be doing to get better.

In very rare cases, there may be something more serious or underlying that requires medical advice. An emergency scan may be arranged for you if experience any of the following:

• Feeling unwell with your back pain such as a fever or significant sweating that wakes you from your sleep
• Difficulty passing urine or having a sensation to pass water that is not there
• Impaired sexual function such as loss of sensation during intercourse
• Numbness / tingling in your genitals or buttocks area
• Loss of bladder or bowel control
• Loss of power in your legs

If you do develop any of the symptoms listed above then we recommend you return to the Emergency Department immediately for further assessment

Is surgery an option?

A very small amount of people with lower back pain actually need surgery. There are some uncommon back conditions where there is pressure on the nerves that supply the legs. The patient reports leg symptoms such as pain, pins and needles or numbness.  For these conditions, surgery can help the leg symptoms but it is not always required as it often resolves on its own.

Usually the outcomes for patients undergoing back surgery are no better in the medium or long term than non-surgical intervention such as exercise.  As a result non-surgical options such as exercise and activity should always be tried first.

What pain relief medication can I take?

Paracetamol and ibuprofen can be purchased over the counter and can be very effective to ease your pain. Take as advised by your clinician or community pharmacist. Always follow the printed instructions provided with these medicines.

You may be given a muscle relaxant medication called diazepam for a few days to help reduce the muscle spasms you are experiencing. These may make you drowsy and so you MUST NOT drive or operate machinery whilst using these.

Although pain relief medication helps to ease the pain you experience, they do not necessarily speed up your recovery. It is advised they are used together with other measures, such as exercise, in the short term only as they can have side effects.

Exercise and rest

In the first few days of a new episode of back pain, avoiding aggravating activities may help to relieve pain. However, prolonged rest and avoiding activity leads to higher levels of pain, greater disability, poorer recovery and longer absence from work.

To aid your recovery you should stay as active as possible and return to all usual activities gradually, this includes staying in work where possible.  Exercise is shown to be very helpful in easing and helping to recover from back pain and the most effective way of preventing further episodes. Your back will get stronger with movement.

No one type of exercise is proven to be more effective than another so choose something you enjoy. Start slowly and build up both the amount that you do and the intensity. Your back may initially be a little sore during or after you exercise but over time you will find that this will reduce.

Sleep

The importance of sleep in tackling back pain has become increasingly clear in recent years.  Sleep reduces stress and improves your overall feeling of wellbeing; making you less susceptible to the triggers of pain and helping you cope if it does occur. Aim for 7.5 – 8 hours a night and try to aim for a regular routine, as far as possible. There is no recommended position for sleep or particular type of mattress – do whatever feels most comfortable for you.

It is a common misunderstanding that bending and lifting are often the cause of back pain and while an injury can occur if something is picked up in an awkward manner, it is most likely to be just a sprain or a strain.

Bending and lifting

The most important thing is to practice and get your body used to carrying different loads and weights in a way you find comfortable and efficient.

There are some tips below to prevent and avoid injury.  Always take into account:

Task

• Individual capacity
• Load
• Environment

When lifting an object by hand

• Reduce the amount of twisting, stooping and reaching
• Avoid lifting from floor level or above shoulder height, especially if the object is heavy
• Adjust storage areas to minimise the need to carry out such movements
• Consider how you can minimise carrying distances
• Assess the weight to be carried and whether you can move the load safely or if you need help – maybe the load can be broken down to smaller, lighter components

For more detailed information on safer techniques for lifting visit: http://www.hse.gov.uk/toolbox/manual.htm

When to seek further help

If your back pain does not settle after 6 – 8 weeks and you have not already done so you should refer yourself to a physiotherapist.

• Hull GP patients call (01482) 300003
• East Riding GP patients call (01377) 208300 (open Mon-Fri 09.00am -13.00pm, excluding bank holiday) or self-refer online at chcpmsk.org.uk
• Out of area please seek a referral from your GP

Physiotherapists provide expert advice guidance and treatment for back pain. This is to help reduce your chances of future episodes, while improving your overall health and wellbeing.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.