Musculoskeletal (MSK) problems are very common, widely range from over 200 different conditions and represent 30% of all GP consultations. Among these, the number one complaint is ‘back pain’ .
Following this, most forms of back pain are focused in the lower back, or the ‘lumbar spine’.
For the vast majority of cases, the cause of lower back pain is unknown (also known as “non-specific”), is usually self-limiting (lasting up to 4 weeks) and can be managed by :
- Staying active – doing specific exercises that help the back. Swimming is a great way to do this without putting pressure on the spine.
- Medication – Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen and naproxen, but also paracetamol
- Heat – some people find using a heated pad helps to relieve the pain
If none of these help, there are more options that the doctor can offer or advise you on.
Back pain: when should I be worried?
As mentioned, the sinister causes of back pain are reassuringly rare – around 85% are non-specific and therefore do not have a worrying cause such as cancer (which is even rarer, at 0.7%, and has tell-tale signs that will be picked up by a professional) .
The main objective of the doctor is to rule out the more alarming causes of back pain. These are the red flags :
- Cauda equina syndrome – this is when the lowest part of the spine is so compressed that it encroaches on the nerves exiting the spine. Signs are loss of bowel or bladder control, numbness/tingling sensation of the groin area and weakness or paralysis of the lower limbs.
- Fracture of the spine – usually preceded by a history of trauma (e.g. car accident or fall from great height). Signs include a history of regular corticosteroid use, sudden onset of severe central spinal pain which is relieved by lying down, spinal deformity and tenderness over one particular bone (‘vertebra’) of the spine.
- Cancer – more common if you have a past history of cancer, particularly breast, kidney, prostate, thyroid and lung cancer. Signs include unintentional weight loss, age 50 years or older, gradual onset, thoracic pain (portion of the back connected to the ribs, see image) and constant severe pain that disrupts sleep and is worse on straining (e.g. on the toilet).
Infection – usually accompanied by the regular symptoms of infection. Signs include fever, recent tuberculosis infection, history of IV drug use, diabetes or being immunocompromised or immunodeficient (e.g. HIV, use of immunosuppressants, chronic corticosteroid use or a pre-existing condition of the immune system).
MSK issues are one of the most common presentations to the GP in the UK and amongst the 200+ conditions, back pain is the most common. In turn, most causes of back pain are “non-specific” in that there is no alarming cause and it is self-limiting. There are a wide range of ways to treat this type of back pain and it should be noted that back pain goes away within a few weeks.
If your back pain persists, it’s a good idea to call the doctor and seek referral for a physiotherapist.
References: https://www.england.nhs.uk/ourwork/clinical-policy/ltc/our-work-on-long-term-conditions/musculoskeletal/  https://www.acpjournals.org/doi/10.7326/0003-4819-160-11-201406030-01006?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&  https://www.nejm.org/doi/10.1056/NEJM200102013440508?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed  https://cks.nice.org.uk/topics/back-pain-low-without-radiculopathy/diagnosis/red-flag-symptoms-signs/
Reference for image (wiki open source):