NHS explain the best ways to treat back pain

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Around 20 percent of Brits with lower back pain see their GP about the problem, resulting in 2.6 million consultations a year about lower back pain. Shockingly, 12 months after their first episode of back pain, 65 percent will still have back pain, and 16 percent remain unable to work because of it. In 2016, 31 million working days were lost because of back pain, and the NHS costs are estimated to be £12.3 Billion per year. How does lower back pain happen and who is at risk? Express.co.uk chatted to Dr Deborah Lee from Dr Fox Online Pharmacy to find out the 15 causes of lower back pain.

More than eight million UK adults say they are living in chronic pain thanks to their lower back troubles.

Back pain has physical, psychological, and social effects, disrupting the ability to execute daily tasks, sleep and exercise.

Dr Lee said: “It results in sadness, anxiety and depression, loss of hope for the future, and causes further health anxiety.

“Lower back pain curtails daily life due to the inability to go out, leading to social isolation, and being unable to participate in hobbies and pastimes.”

The structure of the lower back is complex and it’s made up of the five lumbar vertebrae – L1 – L5.

Dr Lee explained: “These are held together to form a column, by muscles and ligaments.

“The lumbar spine provides support for the back and takes most of the weight of the upper body.

“The spinal cord travels down the middle of the vertebral column. Nerves branch out between the vertebrae to supply the lower limbs and other parts of the body.

“In between each disc is an intervertebral disc – a soft pad, made of cartilage, that cushions the spinal movements.”

The lower back is a far more frequent cause of back pain than the upper back because the lower part of the back bears the mechanical load, Dr Lee said.

The doctor explained: “If something goes wrong, often because we lift a heavyweight and the load is too heavy, or the spine is twisted, this can cause spinal disc prolapse, muscle and ligament tears and sprains, and spinal fractures.

“The vertebral joints are also common sites for arthritis.”

Dr Lee has revealed the top 15 causes of lower back pain, and some of them are connected to the spinal cord and nerves and others are linked to conditions.

Trauma/injury

Any accidents or trauma, for example, Road Traffic Accidents, or sports injuries – can result in sprains and tears in muscles and ligaments of the lumbar spine.

Dr Lee said: “Sometimes this can cause the intervertebral discs to prolapse or rupture, which means the disc is now pressing on the spinal cord.”

Degenerative disease

As we age, due to general wear and tear, our joints gradually deteriorate.

Dr Lee explained: “The intervertebral discs shrink, meaning the disc space is reduced, and the nerve roots become pinched.

“Bone spurs may also develop which often press on nerve tissue.

“The spine loses mobility and becomes stiffer. This whole process is sometimes called spondylosis.

“If as a result, the spinal canal becomes narrowed, this causes spinal stenosis – a serious condition where intense pressure on the spinal cord causes pain, numbness, and difficulty walking.”

Arthritis

Most commonly osteoarthritis (OA) but other types of arthritis such as Rheumatoid arthritis and ankylosing spondylitis all affect the lower back. OA is a common cause of degenerative disease.

Dr Lee said: “ In arthritis, there is inflammation within the joint, joint swelling, muscle weakness and erosion of bone and cartilage.”

Sciatica

This is the name for the symptom of pain which shoots down the back of the leg.

Dr Lee noted: “It is caused by pressure on the sciatic nerve, usually from a prolapsed or herniated disc.”

Spinal stenosis

As described above, spinal stenosis is present if arthritic changes or a prolapsed disc results in narrowing of the spinal canal, putting pressure on the spinal cord.

This is usually a disease of people over age 60 – affecting about one in 1,000 people.

Spondylolisthesis

This occurs when one vertebra slips forwards, putting pressure on the nerves as they project between the vertebrae.

Infections

Infections can occur, such as osteomyelitis, or discitis.

The most common organism is the bacteria, staphylococcus aureus, occurring in intravenous drug users, Dr Lee said.

Cauda equina syndrome

This is a medical condition in which ruptured disc presses on the spinal cord causing symptoms in the lower limbs, and sometimes the bowel and bladder.

If untreated it can result in permanent neurological damage, so this is an emergency.

Osteoporosis

This is a disease characterised by loss of bone architecture.

Over time, calcium is lost from the skeleton, the bone becomes less dense, weaker and more prone to fracture. In the spine, osteoporosis causes vertebral fractures.

Around 25 percent of postmenopausal women sustain a vertebral fracture at some point. Dr Lee said: “Although they can be extremely painful, many of these fractures are surprisingly painless.”

Kidney stones

These often cause severe, unilateral back pain.

A kidney stone can block the ureter – the tube carrying urine from the kidney to the bladder, causing the kidney to swell.

Endometriosis

This is a very painful condition where the womb lining, the endometrium, exists outside the womb in the pelvic tissues.

Dr Lee said: “When a woman has a period, the additional tissue bleeds internally, causing excruciating pain.

“The bleeding results in scar tissue in the pelvis and can cause low abdominal/pelvic pain, painful sex and low back pain.”

Fibromyalgia

Sufferers seem to get inflammation of cartilage, along with a heightened pain response. Back pain, both upper and lower, is common.

Tumours

Spinal tumours are rare, but when they occur, they can grow and compress the spinal cord or the nerves exiting in between the vertebrae.

Dr Lee explained: “In young people, spinal tumours are often benign.
Osteosarcomas, multiple myeloma and secondary metastatic tumours can also occur.”

Pregnancy

Estrogen increases joint laxity, hence in pregnancy, when estrogen levels are high, low back pain is common.

Abnormal spinal curvature

A kyphosis (the spine curves forwards), scoliosis (an S-shaped spine) or a lordosis (the lower back curves too far inwards) can all cause low back pain.

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