WHAT IS PAIN?

Back & Neck Pain

Almost all conditions that can affect your back can also affect your neck. Most of the information below is relevant to back and neck pain.

Possible back problems Back pain is an enormous problem both to individuals and to society. It has been said that between 80–90% of people will experience an episode of low back pain at some time in their life. One of the major concerns with acute back pain injuries is the prevention of the injury becoming a long term one, with all the individual, social and healthcare costs that chronic conditions incur.

Guidelines have been produced to treat back pain with the emphasis to maintain activity and reduce work loss. The guidelines recommended a triage system, with the huge majority of patients fitting into the simple back pain and therefore not requiring urgent referral for nerve root pain or spinal pathology.

There is a ‘red flag’ system in place to ensure that those patients, who require more urgent specialised care, receive it. If you meet one or more of these criteria, you should see your GP or pain specialist urgently.

  • Do you have severe back pain aged under 20 or over 55?
  • Is the pain in the middle of your back, thoracic pain?
  • Do you have a history of cancer or HIV?
  • Have you been unwell, or had sudden unexplained weight loss?
  • Do you have severe widespread pain, for example down both of your legs?
  • Do you have a deformity of your back or neck?
  • Do you have severe and persistent pain in the night?
  • Are you numb around your bottom and thighs (saddle anaesthesia)?
  • Are you suddenly having trouble either with passing water or faeces or with being incontinent?

If you have any of these signs or are worried, you should see your GP or pain specialist

For simple back pain – if you have back pain, without any of the above ‘red flags’, the early management strategy is simple painkillers, you should rest for 1-2 days only if essential, you will encouraged to get back to normal activity, physical therapy may be recommended, and advised about returning to work as soon as you can.

Studies have concluded that following an acute low back pain injury, continuing normal activity within the limits permitted by the pain led to a more rapid recovery than bed rest or back exercises.

The image above shows some of the conditions that can cause back or neck pain, and some of the more common problems are briefly discussed below. Your Pain Medicine Consultant will be able to discuss any issues you have in more details. Please ask if you have any questions.

  • People who have a back problem often talk about having a 'slipped disc'. But disc problems are actually not common - and never happen because the disc has 'slipped'. It has usually torn and become distorted ('prolapsed' or 'herniated') so that it presses against sensitive nerves from the spinal cord.
  • Sciatica is the name given to pains running down the leg because the sciatic nerve from the spinal cord has been pinched or irritated by damage to the back - sometimes a prolapsed disc.
  • Spine movement is made possible by joints between the vertebrae consisting of two flat faces or facets on the bone. If these degenerate, the two halves of the joint grate painfully against each other.
  • Some diseases can contribute to back pain and are likely to need long-term treatment. But they're far less common than minor damage to the back's muscles and ligaments. It's a good idea to visit your GP if your back pain doesn't go away after a week or so.
  • Osteoarthritis is a long-term condition of degeneration of the joints, which makes them less able to withstand stress. It is a wear-and-tear problem that affects most of us as we get older and which can give rise to pain in some cases.
  • There are many inflammatory diseases (e.g. ankylosing spondylitis and rheumatoid arthritis) that cause joints to become inflamed and seize up. These diseases can either directly affect the joints in the back or cause problems with other joints that lead to pain in the back.
  • Osteoporosis causes bones to become weak so they more fracture easily. The bones of the back and neck are often affected and can become compressed. This is particularly common in women who are post-menopausal and can be influenced by diet and hormone replacement therapy (HRT).