Backed against a wall

Posted on: 30 October 2018 by 50connect editorial

Back pain affects 21.9 million people in the UK, but the list of what isn’t recommended is now longer than what is…

back pain

Back pain is a very common condition. It affects around a third of the UK adult population each year, this is 21.9 million people in the UK alone.

It is a condition often caused by a simple muscle, tendon or ligament strain and not usually by a serious underlying medical problem. It can be acute, where the pain starts quickly but then reduces after a few days or weeks, or chronic (severe), where pain might last on and off for several weeks or even months.

What you shouldn’t do…

“Unfortunately there is no simple and proven way to cure back pain that works for everyone,” comments GP Dr Sarah Jarvis, who frequently sees patients of all ages with back pain, “And advice has changed over the years: for example many GPs would advise ‘bed rest’ thirty years ago, whereas now exercise is recognised as a more effective treatment. The good news is we have a growing body of research and more evidence than ever before on what does and does not work.”

Here is a summary of what treatments are no longer recognised in the management of back pain:

  • Acupuncture - The practice of acupuncture was no better than a placebo in treating those living with low back pain and sciatica shows a report conducted in 2011.2 However many people find this to be an effective treatment
  • Steroid injections – Previously recommended for patients ahead of surgery, these injections - costing £540 per procedure - have been shown to have no long term effects and are no better than a placebo for many patients. They are no longer recommended by NICE except for some patients with sciatica.
  • Back pain surgery – Surgery is generally only recommended for patients with certain types of severe long term back pain caused by a trapping of the spinal nerves. It takes a long time to recover from this major surgery, success is not guaranteed and complication rates are significant – as high as 20% for some surgeries.
  • Paracetamol alone - Paracetamol alone is unlikely to help people with back pain, and is no longer recommended by NICE.
  • Opioids - Opioids can only be prescribed on a short term basis (opiates are in the same classification as drugs like Morphine. Unfortunately the body quickly develops a tolerance to these drugs meaning we need to increase the dose to maintain their effects. When taken at high doses these medications can also have a paradoxical effect of increasing pain and can be highly addictive6  Treatment for drug misuse cost the NHS £0.5 billion in 2014 

So what can you do?

“The changes in recommendations can be perceived as a lack of treatment options for people with back pain and it may contribute to feelings of helplessness” comments Dr Anna Mandeville, a psychologist specialising in pain management.

Here is a summary of treatments, which clinicians can recommend to patients complaining of back pain:

  • Physical programme - The advice given 30 years ago was to rest, but research has shown that inactivity only makes things worse. The Self-Care Forum recommend staying active with regular day-to-day activities to avoid becoming sedentary - so avoiding lying in bed, trying back exercises such as the Alexander technique and remaining active as far as possible.
    • “A self-management programme – with physical and psychological elements – helps us to change thoughts and behaviours which may be unhelpful and reduces the impact symptoms have on our everyday life” adds Dr Anna Mandeville
    • Mind Your Back is a physical program comprising the 5 S.T.E.P.S. which is designed specifically to help alleviate back pain and prevent future occurrences. For more information please visit mindyourbackuk.com.
  • Manual therapy - In manual therapy, practitioner’s like physiotherapists and osteopaths, use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension and joint dysfunction. The average waiting time for a referred appointment to see a NHS physiotherapist is 10-12 weeks. However learning about self-management approaches and exercise means that patients can achieve effective results without the need to rely on a health practitioner in the long term.
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
    • Topical NSAIDs: A review of 61 studies of topical NSAIDs concluded that these products provide “good levels of pain relief in acute conditions”. The review also found very few ‘adverse events’ like digestive tract irritation or cardiovascular complications. While oral NSAIDs may react with drugs, topical alternative have fewer interactions (as less of the drug is absorbed)
    • Oral NSAIDs: Ibuprofen is an example of an NSAID that reduces swelling. However, NSAIDs may not be suitable for patients with other health problems, such as those with gastrointestinal problems, chronic kidney disease or on other medications that interact with oral NSAIDs. 12 Oral NSAIDs can cause gastrointestinal problems if used for an extensive period of time
  • Hot or cold therapies can also provide relief
    • Heat therapy - Heat therapy application can help provide lower back pain relief. It does so via the dilation of blood vessels and the facilitation of stretching of the muscles and ligaments. The dilation of the blood vessels also allows for an increased blood flow which brings oxygen and nutrients to the affected area. It can be done in the form of heating pads, heat wraps or topical creams
    • Cold therapy - Cold therapy slows the inflammation and swelling that occurs after injury. Most back pain is accompanied by some type of inflammation, and addressing the inflammation helps reduce the pain. The cold therapy also numbs the afflicted area and slows nerve impulses reducing the pain. Similarly to heat therapy this can be done with variations of ice packs, cool patches or topical creams

A sigh of relief

For many treatments patients are waiting up to 3 weeks for a GP appointment, when they should be being treated in secondary care. However as these secondary care referrals also have waiting times upwards of 18 weeks, as such patients may wish to consider other methods of self-management to reduce their pain and keep them active. Patients could also consult with their pharmacist to discuss what treatments are available over-the-counter.

While there are limited options for patients, cooling therapy and topical NSAIDs such as Deep Relief, Jointace and Voltarol, or ibuprofen gel, are recommended.

For long lasting benefits follow treatment with light exercise and stretching, for tips on this please go to https://www.mindyourbackuk.com/ to see the 5 S.T.E.P.S.

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