Back pain usually affects the lower back. It can be short-term, lasting a few days or weeks, or for some people, a long-term condition. Most people will have some form of back pain at some stage in their lives.
About back pain
Back pain is extremely common - about 80 percent of people are affected at some point in their lifetime. Anyone can get back pain at any age, but it's more common in people over the age of 35.
Your back has many interconnecting structures including bones, joints, muscles, ligaments and tendons. Its main support structure is the spine, which is made up of 24 separate bones called vertebrae, plus the bones of the sacrum and coccyx. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads down through the central canal of each vertebra, carrying nerves from your brain to the rest of your body.
You may experience low back pain as tension, soreness or stiffness in your lower back area. This pain is often referred to as 'non-specific' back pain and usually improves on its own within a few days.
Back pain may be called either 'acute' or 'chronic' depending on how long your symptoms last. You may have:
- Acute back pain - lasting less than six weeks
- Sub-acute back pain - lasting six weeks to three months
- Chronic back pain - lasting longer than three months.
Causes of back pain
It's often very difficult to know exactly what causes back pain. It's usually thought to be related to a strain in one of the interconnecting structures in your back, rather than a nerve problem. For most people with back pain, there isn't any specific underlying problem or condition that can be identified as the cause of the pain. However, there are a number of factors that can increase your risk of developing back pain, or aggravate it once you have it. These include:
- standing, sitting or bending down for long periods
- lifting, carrying, pushing or pulling loads that are too heavy, or going about these tasks in the wrong way
- having a trip or a fall
- being stressed or anxious
- being overweight
- having poor posture.
There may be other, more serious underlying causes of your back pain, but these are rare. They include:
- fracture - a crack or break in one of the bones in your back
- osteoporosis - a condition where bones become weak, brittle and are more likely to break
- a slipped disc - this is when a disc bulges so far out that it puts pressure on your spinal nerves
- spinal stenosis - a narrowing of the spinal canal through which the spinal cord passes
- spondylolisthesis - when one of your vertebrae slips forward and out of position
- degenerative disc disease - when the discs in your spinal cord gradually become worn down
- osteoarthritis - a wear-and-tear disease affecting the joints between your vertebrae
- rheumatoid arthritis - an inflammatory condition in which your immune system causes inflammation of the lining of your joints and surrounding structures.
Back pain may also be caused by an infection or cancer, but these two causes are very rare.
Red flags
See your GP as soon as possible if you experience back pain and one of the following problems:
- A fever (high temperature)
- Redness or swelling on your back
- Pain down your legs and below your knees
- Numbness or weakness in one or both legs or around your buttocks
- Loss of bladder or bowel control (incontinence)
- Constant pain, particularly at night
- Pain that's worsening and spreading up your spine.
These symptoms are known as red flags. It's important to seek medical help for these symptoms to ensure you don't have a more serious, underlying cause for your back pain.
Diagnosis of back pain
If you have back pain, further testing is not normally recommended unless your symptoms don't improve after a few weeks or if you have one of the red flags [see box]. If your GP sends you for tests you may have:
- an X-ray
- a CT scan - a test that uses X-ray equipment and computer software to create images of the inside of your body
- an MRI scan - a test that uses magnets and radio waves to produce images of the inside of the body
- blood tests
These tests are used to find out if you have a more specific, underlying cause for your back pain.
Treatment of back pain
Self-help measures are often very helpful in people with back pain. If your back pain is severe or chronic your GP may prescribe appropriate medicines or refer you for manual (physical) therapies. If an underlying cause of back pain is suspected, your GP may refer you to a back or pain specialist or clinic for diagnosis and specialised treatments (such as spinal injections).
Self-help
There are a number of things you can do to help relieve low back pain.
- Stay active and continue your daily activities as normally as you can. There is strong evidence that this leads to a faster recovery and reduces the chance of chronic pain and disability. Prolonged bed rest may make back pain worse, so after the first few days limit the time you spend in bed.
- Avoid heavy lifting and twisting for about six weeks or until your pain resolves.
- Apply hot or cold packs to the affected area. You can buy specially designed hot and cold packs from most pharmacies. If you prefer, you can apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. Don't apply ice directly to your skin.
Medicines
Taking an non-prescription painkiller (such as aspirin or paracetamol) or anti-inflammatory medicine (such as ibuprofen) is often enough to relieve acute low back pain. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients. Make sure you don't apply an anti-inflammatory cream as well as taking an anti-inflammatory tablet or capsule as they can interact. Talk to your GP or pharmacist for more advice about using anti-inflammatory medicines.
If your pain is severe or chronic, your GP may prescribe stronger medicines.
Always read the accompanying consumer medicines information leaflet and if you have any questions, ask your pharmacist for advice.
Manual (physical) therapies
Manual (physical) therapies can be helpful for back pain. Treatment can involve exercises, posture advice and massage. Treatment courses usually last about six to 12 weeks.
Surgery
Back pain can usually be managed successfully with the simple treatments listed above, but about 10 percent of people have ongoing problems. Back surgery is usually a last resort in people who have an underlying cause for their pain.
Complementary therapies
Some people find acupuncture can help relieve low back pain.
Alternatively, you could try a pain-management program to help you better deal with and manage your symptoms.
You should always talk to your GP before trying any complementary therapy.
Prevention of back pain
Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:
- take regular exercise - walking and swimming are particularly beneficial
- try relaxation techniques to keep your stress levels to a minimum
- bend from your knees and hips, not your back – particularly when lifting objects and people
- maintain good posture - keep your shoulders back and don't slouch.
Further information
Pain Australia
www.painaustralia.org.au/
Sources
Briggs AM Buchbinder R. Back pain: a National Health Priority Area in Australia? Medical Journal of Australia. 2009; 190: 499-502.
Chou R Qaseem A Snow V et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007; 146: 478-91.
Dahm KT Brurberg KG Jamtvedt G et al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews. 2010, Issue 6. doi: 10.1002/14651858.CD007612.pub2
National Health and Medical Research Council. Evidence-based Management of Acute Musculoskeletal Pain. [online] Dec 2003. [Accessed 29 June 2011] Available at: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp94.pdf
Furlan AD Imamura M Dryden T et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2010, Issue 4. doi: 10.1002/14651858.CD001929.pub2
Furlan AD van Tulder MW Cherkin D et al. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews. 2005, Issue 1. doi: 10.1002/14651858.CD001351.pub2
Hayden J van Tulder MW Malmivaara A et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews. 2005, Issue 3. doi: 10.1002/14651858.CD000335.pub2
National Institute for Health and Clinical Excellence (NICE). Low back pain: Early management of persistent non-specific low back pain. [online] 2009 [Accessed 1 Jul 2011] Available from: http://guidance.nice.org.uk/CG88
National Institute of Clinical Studies Emergency Care Community of Practice. Lumbar Imaging in Acute Non-Specific Low Back Pain: A summary of best available evidence and information on current clinical practice. [online] Emergency Care Evidence in Practice Series. 2008 [Accessed 29 June 2011] Available at: http://www.nhmrc.gov.au/_files_nhmrc/file/nics/news_events/080221_lumbar_imaging.pdf
Sahar T Cohen MJ Ne'eman V et al. Insoles for prevention and treatment of back pain. Cochrane Database of Systematic Reviews. 2007, Issue 4. doi: 10.1002/14651858.CD005275.pub2
van Duijvenbode I Jellema P van Poppel M et al. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews. 2010, Issue 2. doi: 10.1002/14651858.CD001823.pub3
Last published: 30 July 2011
