Lower Back Pain (with or without Sciatica)
Lower Back Pain (with or without Sciatica)
Back pain is a common complaint, which in most cases will get better by itself within 2–6 weeks. There is usually no serious underlying medical cause. The best treatment is generally to keep as active as possible. Lower back pain (also known as lumbago) is particularly common, but back pain can affect any part of the spine.
In many cases, there is no identifiable cause of back pain, in which case it is called "non-specific".
Persistent Back Pain
Persistent back pain is pain in your back that lasts for more than 3 months. Persistent back pain can be more difficult to manage - treatment can include a combination of medication, and input from physiotherapists and/or psychologists.
However, remember that your back is one of the strongest structures of your body. Continue to remain active - even if it's painful, moving will make you stronger. Keeping active is the best thing you can do. Movement may be painful at first, like when you sprain your ankle, but it will get better as you become more active. Sleeping well, regular exercise, a healthy diet, and cutting down on smoking will all help as well.
If you develop bladder or bowel symptoms, feel generally unwell, or if the pain doesn’t settle within a few weeks, talk to your GP.
If you need to take pain relief to help keep you moving, you can take simple over-the-counter NSAID painkillers (such as Ibuprofen). If you have health issues that mean you can't take these types of medications (gastrointestinal, liver and cardio-renal toxicity), then speak to your GP or pharmacist first. Do NOT take paracetamol alone for low back pain. It doesn't work.
In the past, you may have been prescribed medications for your pain. These may be Opioids (such as Codeine, Fentanyl, Morphine, Methadone, or Zomorph) or Gabapentinoids (such as Gabapentin or Pregabalin).
New research has shown that these aren't very effective at treating long-term pain. It has also shown they can be dangerous. It shows that:
- Many patients find that opioid painkillers don't help with their persistent pain. Many find they can also cause unpleasant side effects including nausea, vomiting, dizziness and constipation.
- There is no conclusive evidence that opioids are effective in the long-term treatment of persistent pain.
- Opioids can be addictive. There are increasing numbers of overdoses. The more of them you take, the less effective they become, and so you can very easily end up taking more than is good for you.
- Very few patients find Gabapentinoids effective in treating persistent pain. Large numbers of patients also experience side effects including dizziness, confusion, light-headedness, constipation and problems with vision.
If you have had these painkillers prescribed to you, PPSS may be able to support you to review your medications and work with you to see what is best for you in the longer term.
Scanning and Imaging
Changes in your back as you go through life are to be expected - just like getting grey hair. Back pain is very common and not something that you should worry will get worse as you get older. The chances are it won’t.
Back pain does not mean your back is damaged. Backs are not easily damaged. Despite what you may have heard, discs cannot slip. Scanning your back will not tell your GP how you can manage the pain, nor will it tell us how to make your back better. In many cases, the scans of someone with back pain will look exactly the same as someone without back pain.
Back Injections and Other Treatments
In the past, you may have had spinal injections for persistent back pain, for example nerve blocks, epidurals, or facet joint injections.
Research has shown that there is no strong evidence that nerve blocks, epidurals or facet joint injections are effective in helping back pain in the long-term. They can also carry some risks. Although the risks are small, complications and side-effects of spinal injections can include allergic reactions, infection, abscess, vision loss, stroke, nerve damage, increased pain or pain elsewhere, stiffness, numbness, bleeding, and paralysis.
When we are treating patients, NHS organisations have to follow guidance set by the National Institute for Clinical Excellence (NICE). NICE has looked at this research and in November 2016 decided that we should no longer offer spinal injections to treat back pain.
In addition to changes in spinal injections and medications, NICE have also concluded that there is no clinical evidence that other treatments such as Acupuncture, TENS machines, traction, belts, corsets, orthotics, or rocker shoes work either.
The NHS will also stop offering surgery to correct back pain. In the past some people have been offered spinal fusion or disc replacements. Any surgery comes with its own risks. In some cases the surgery can risk damaging other areas of your back, and there is evidence that the scar tissue associated with surgery can leave you with more pain than the surgery aimed to resolve.
NICE Guidance on Low Back Pain
'Managing Your Back Pain' Booklet (Tasmanian Health Organisation)
Please note paracetamol is mentioned in this booklet as an effective painkiller but is no longer recommended for back pain.