Well, the actual cause of lower back pain is unknown
but it’s more important to rule out the most serious things which can give rise to back problems
such as cancers, infections, inflammatory problems, and even trauma.
A lot of the time, people present with back problems to the specialist,
and it’s crucial that the more serious problems are ruled out first.
Well there are certain features which will
give rise to concern, features to do with their age, so if you have a patient who’s
over 50 or an individual who’s under the age of 20.
There are other features that are associated with the type of pain
so if you have an unremitting pain which disturbs sleep
which interferes with normal daily activities, then that is a cause for concern.
There are also other features like associated weight loss.
If you have patients who had a past history of cancer
or on medication such as steroids or have even had fractures in the past,
these sorts of things will tend to raise the alarm bells
and these types of patients must be investigated thoroughly.
So after excluding the more serious causes of lower back pain,
we start with the simple measures such as encouraging people to remain as active as possible.
Some patients would benefit from physiotherapy which will take different forms in terms of engagement.
Usually as a preliminary treatment, patients are shown
exercises to do themselves and then they give them leaflets to take home.
If that doesn't work, then the physiotherapy often become more involved
taking the patients through exercise sessions on a regular basis.
And then we then move on to more invasive treatments if you like
such as injections if back pain is associated with leg symptoms as well.
So cortisone injections can be used to treat pain.
And then for those patients who perhaps have had pain going on for a while
and it’s starting to interfere with not just their own personal space
but also other aspects of their day to day life such as work
resulting on time off work or time away from friends because they’re not able to go out,
then a more combined approach where not only do they go through physiotherapy but then
you also add in psychological treatments to help them learn to develop coping strategies
to deal with their back pain and this has been found to be a very useful way of treating people.
And then in the background, there’s also the use of simple over the counter medications
such as paracetamol anti-inflammatory tablets to help to control the pain
while the patient gets on with their normal daily activities as best they can.
So sometimes, you can have a situation where a patient had back pain for a while
in association with leg pain secondary to a disc herniation
or a slipped disc if you like.
And in very rare circumstances, this can present as an emergency
where the nerve supply to the bowels and the bladder is at risk
and in situations such as this, then surgery is necessary
but the surgery is really to deal with the leg symptoms
and also to preserve the patients bowel and bladder function and prevent long term disability.
There are also instances where you can have mechanical back pain
due to developmental problems with the spine that can then go on to cause leg symptoms as well.
So in these sorts of instances, surgery is appropriate
to deal with the mechanical problems around the spine
and also to address the leg symptoms at the same time.
This is usually done with a procedure that’s called a spinal fusion
and nowadays, the fusion process is facilitated by using metal work.
(in simple terms, a scaffolding on the spine)
to not only provide stability but then to help the spine to fuse to help with the pain.