Back Pain

Introduction

Back pain is a symptom

Backache is not an illness in itself, but a symptom. Its development means that something has gone wrong somewhere, although it may not always be clear exactly where or what.

Most of us suffer from backache at some time or other. Usually it is an unpleasant, awkward but not desperately serious problem caused by some kind of mechanical stress or damage within the back which gets better fairly quickly. Poor posture, excessive stresses, and wear-and-tear problems may be at least partly responsible.

You should not be surprised that backache is so common when you realise that your spine is composed of many different structures, including bones, discs, ligaments, tendons, nerves, blood vessels and other tissues, all of which can be affected by mechanical damage resulting in backache.

In most cases the precise cause of the problem is not important. Backache is a symptom that will clear up; the purpose of treatment is to relieve pain and to make sure that you recover as soon as possible. Occasionally there may be a more severe underlying cause and detailed investigations are required to decide the right approach to treatment. Understanding how the back works will help us to protect our spines and recover more rapidly from attacks of backache.

This booklet aims to show you how the back works, what goes wrong, why back problems arise and how they are treated, and to give some indication of when further investigations and specialised help are necessary.

A growing problem

Backache is remarkably common. At any one time some 30 to 40 per cent of the population have backache and between 80 and 90 per cent experience it at some time in their lives. It affects both sexes and all ages from children to elderly people, but is most prevalent in the middle years.

Time off work

Backache is one of the most common reasons why people have to take time off work, especially in heavy manual industries. At particular risk are workers in the building industry and nurses who often have to undertake heavy lifts in awkward postures.

It’s often hard to separate cause and effect: in other words, do the stresses in the job cause the backache, or is the person unable to do heavy work because he or she already has a bad back? In many cases, back pain follows some injury or a sudden twist. Much time is now spent training workers to avoid subjecting their backs to excessive stresses.

The scale of the problem

The amount of working time lost as a result of back problems has increased enormously in recent years. It is now running at some 100 million working days per year in England and Wales, two or three times more than 20 years ago. In fact, this dramatic rise does not mean that more people are being injured at work. Rather, it reflects the more concerned approach taken by both workers and employers to the effects of back pain. The result is a dramatic escalation in the costs of back pain to our society. This is now calculated as nearly £6,000,000,000 (six billion pounds) per year for the medical treatment provided, the benefits received and loss of production – a phenomenal sum.

The increase in the numbers of people disabled by back problems has led to a complete rethink of our approach to back pain and how it is treated. In this booklet I provide the most up-to-date views based on the latest research on the treatment of back pain, and explain how we are attempting to reduce the frequency and severity of this problem.

KEY POINTS

• Backache is a symptom not a disease

• Acute episodes of back pain, although unpleasant, usually get better quickly

• Backache affects 80–90 per cent of the population at some time in their lives