Sun | May 19, 2019

Dear Doc | Should I be worried about lower back pain?

Published:Sunday | March 17, 2019 | 12:05 AM

Q Dear Doc, how worried should I be about lower back pain? I have had it for some time now and I have only received painkillers for it. I am now wondering if it is something serious and if I should be doing CAT scans, or something, to look for a cause and not just taking pain medication.

A I do not have that much information on the nature of your back pain, so I cannot tell you how worried you should be; but what I can say is, do not assume the worst. Back pain is a very common complaint in adults and almost everyone gets back pain at some point in their life. I know it can be scary, but it is almost never serious, and usually goes away on its own.

To continue to explain more about back pain, I usually start by explaining to my patient what the back is made up of, as many persons automatically think back pain means spine problems.

The back consists of the following:

- The vertebrae: A stack of bones that sit on top of one another. Each bone looks like an oxtail bone and has a hole in the centre. The bones are stacked in such a way that the hole in the centre lines up to form a tube, and it is in this tube that the spinal cord runs. These bones protect the spinal cord.

- The discs: Are soft, rubbery tissues that are in between each of the vertebrae to allow for movement.

- The spinal cord and nerves: The spinal cord is a vast collection of nerves that connects the brain to the rest of the body. It runs through the vertebrae and sends off branches that pass in between the vertebrae. These branches connect to the arms, the legs, and the organs.

- The muscles, tendons, and ligaments: Together the muscles, tendons, and ligaments support the back and help hold it together.

Lower back pain can arise from any of these parts. Pain can happen if you strain a muscle or hurt a tendon or ligament. Pain can also happen if you have:

• Damaged, bulging, or torn discs.

• Arthritis affecting the joints of the vertebrae.

• Bony growths on the vertebrae that squeeze the nearby nerves.

• A vertebra out of place.

• Narrowing in the spinal canal.

• A tumour or infection.

Regarding your question about the CAT scan. Most cases of back pain go away within four to six weeks, or in even less time. Because of this, most people do not need an imaging test, and doctors usually do not order imaging tests before then, unless there are signs of something unusual.

If your doctor does not order an imaging test, do not worry. He or she can still learn a lot about your pain just from examining you and talking with you, and treatment can start right away, even without an imaging test.

Your symptoms will tell your doctor a lot about the cause of your pain. For example, if your pain spreads down the back of one thigh, that could be a sign that one of the nerves that go to your leg is being pinched by a bulging or torn disc. However, if your pain goes all the way down both legs, that could be a sign that you have bony growths on your spine. This will then guide your doctor in selecting which imaging technique is required, whether it is going to be an X-ray, a CT scan (commonly referred to as a CAT scan) or an MRI.

HOW IS BACK PAIN TREATED?

A small number of people end up needing surgery to treat back pain. But most people do well with simpler treatments, such as:

- Medication: First, you can try pain medicines that you can get without a prescription (over-the-counter medication). We usually suggest trying an NSAID, such as ibuprofen (e.g., Advil) or naproxen (e.g., Aleve) first. These work better than paracetamol (Tylenol) for back pain.

If non-prescription medicines do not help, your doctor will prescribe stronger pain medicines. Sometimes doctors suggest a medicine to relax the muscles (a muscle relaxant).

- Physiotherapy: This is also helpful and will teach you special exercises and stretches.

- Spinal manipulation: This is when someone like a physiotherapist or a chiropractor moves or ‘adjusts’ the joints of your back.

- Massage

- Injections of medicines that numb the back or reduce swelling.

When you start to feel better, ask your doctor about exercises that can help strengthen your back. These exercises can help you get better faster and might make it less likely that you will have pain again. Stay active and learn to lift using your legs instead of your back, and avoid sitting or standing in the same position for too long.

deardoc@gleanerjm.com