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Causes of back pain
Causes of back pain
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Article Author : NHS Choices (May 1, 2013)

Your back is a complex structure made up of bones, muscles, nerves and joints. This can often make it difficult to pinpoint the exact cause of the pain.

Most cases of back pain are not caused by serious damage or disease but by sprains, minor strains, minor injuries or a pinched or irritated nerve.

Back pain can be triggered by everyday activities at home or at work, or it can develop gradually over time as a result of prolonged sitting or standing or lifting badly. Other causes of back pain include:

  • bending awkwardly or for long periods
  • lifting, carrying, pushing or pulling incorrectly
  • slouching in chairs
  • twisting
  • over-stretching
  • driving in a hunched position or driving for long periods without taking a break
  • overuse of the muscles, usually due to sport or repetitive movements (repetitive strain injury

Sometimes back pain develops suddenly for no apparent reason. Some people just wake up one morning with back pain and have no idea what has caused it.

Risk factors

Certain risk factors increase your chances of developing back pain. These include:

  • being overweight – the extra weight puts pressure on the spine; you can use the BMI healthy weight calculator to find out if you need to lose weight. 
  • smoking – this may be due to tissue damage in the back caused by smoking or the fact that smokers tend to have unhealthier lifestyles than non-smokers; get help quitting
  • being pregnant - the extra weight of carrying a baby can place additional strain on the back.
  • long-term use of medication known to weaken bones - such as corticosteroids.
  • stress - stress is thought to cause tension in the back muscles which can result in back pain.
  • depression - back pain can make people feel depressed, which can sometimes result in weight gain which leads to increased pain and worsening depression.

Read more about medical tests for back pain.

In a small number of cases, back pain is caused by a specific medical condition – for example: 

Read about treating back pain

Arthritis

Introduction of arthritis...

Arthritis is a common condition that causes pain and inflammation within a joint.

In the UK, around 10 million people have arthritis. The condition affects people of all ages including children (see below).

There are many different types of arthritis that cause a wide range of symptoms. Two of the most common are osteoarthritis and rheumatoid arthritis. 

What is osteoarthritis?

Osteoarthritis is the most common form of arthritis in the UK, affecting an estimated 8.5 million people.

In people affected by osteoarthritis, the cartilage (connective tissue) between their bones gradually wastes away, leading to painful rubbing of bone on bone in the joints. The most frequently affected joints are in the hands, spine, knees and hips.

Osteoarthritis often develops in people who are over 50 years of age. However, it can develop at any age as a result of an injury or another joint-related condition.

Read more about osteoarthritis

What is rheumatoid arthritis?

Rheumatoid arthritis is a more severe, but less common, form of arthritis than osteoarthritis. It occurs when the body's immune system attacks and destroys the affected joints, causing pain and swelling to occur. This can lead to a reduction in movement and the breakdown of bone and cartilage.

In the UK, rheumatoid arthritis affects around 400,000 people, and  often starts in people between the ages of 40 and 50 years old. Women are three times more likely to be affected by the condition than men.

Read more about rheumatoid arthritis

Symptoms of arthritis

There are many different symptoms of arthritis and the symptoms you experience will vary depending on the type of arthritis you have. However, common arthritic symptoms include:

  • joint pain, tenderness and stiffness
  • inflammation in and around the joints
  • restricted movement of the joints
  • warmth and redness of the skin over the affected joint
  • weakness and muscle wasting

Arthritis and children

Although arthritis is often associated with older people, it can sometimes affect children. In the UK, about 12,000 children under 16 years of age have arthritis.

Most types of childhood arthritis are referred to as juvenile idiopathic arthritis (JIA). JIA causes pain and inflammation in one or more joints for at least six weeks.

Although the exact cause of JIA is unknown, the symptoms often improve as a child gets older, allowing them to lead a normal life.

The main types of JIA are discussed below.

Oligo-articular JIA

Oligo-articular JIA is the most common type of JIA. It affects four or less joints in the body, most commonly in the knees, ankles and wrists.

Oligo-articular JIA has good recovery rates and long-term effects are rare. However, there is a risk that children with the condition may develop eye problems, so it is recommended that they have regular eye checks with an ophthalmologist (an eye care specialist).

Polyarticular JIA (polyarthritis)

Polyarticular JIA, or polyarthritis, affects five or more joints. It can develop at any age during childhood.

The symptoms of polyarticular JIA are similar to those of adult rheumatoid arthritis. The condition is often accompanied by a rash and a high temperature (fever) of 38C (100.4F) or above.

Systemic onset JIA

Systemic onset JIA begins with symptoms such as a fever, rash, lethargy (lack of energy) and enlarged glands. Later on, joints can become swollen and inflamed.

Like polyarticular JIA, systemic onset JIA can affect children of any age.

Enthesitis-related arthritis

Enthesitis-related arthritis is a type of juvenile arthritis that affects older boys or teenagers. The condition can cause pain in the soles of the feet and around the knee and hip joints where the ligaments attach to the bone.

You can read more about arthritis in children on the Arthritis Care website.

Treating arthritis

There is no cure for arthritis but there are a number of treatments that can help slow down the condition’s progress.

Medication can help relieve the symptoms of arthritis. In severe cases, surgery may be recommended.

For osteoarthritis, analgesics (painkillers), non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are often prescribed. In severe cases, surgery may be recommended such as:

  • arthroplasty (joint replacement)
  • arthodesis (joint fusion)
  • osteotomy (where a bone is cut and re-aligned)

Read more about how osteoarthritis is treated.

The aim in treating rheumatoid arthritis is to slow down the progress of the condition and minimise joint damage. Recommended treatments may include:

Read more about how rheumatoid arthritis is treated.

Support groups

Support groups, such as Arthritis Research UK and Arthritis Care offer information, advice and support for people living with arthritis.

You can also use the post code search to find arthritis services in your area and hospitals for arthritis.



"Dancing got me through the roughest tim...

Paul Casimir has been living with arthritis for half his life, but he doesn’t let it stop him from doing the things he enjoys. He tells his story.

Paul Casimir was diagnosed with rheumatoid arthritis at 20. He was a fast runner throughout his teens, but at 19 his body started to stiffen up.

“I had been feeling a little bit strange for about a year before I was diagnosed with arthritis,” says Paul. “I just seemed to move at the pace of a distracted goat. I didn’t really know what was going on. I was at drama school at the time and I kept getting cast as octogenarians.”

One day, after finishing a play, he collapsed into bed completely exhausted. When he woke up, his knees had swollen to the size of dumplings, and he was in bed for four days. His doctor was puzzled.

“It then went away for a while, but returned with a vengeance a couple of months later,” says Paul. "I was referred to a rheumatologist, who diagnosed rheumatoid arthritis. It was something I’d never heard of and I didn’t know why it was happening to me. I had tears in my eyes when she told me.”   

Paul managed his condition with painkillers and anti-inflammatory medication for the next few years. It was difficult for him to move properly. "Dancing was what got me through the roughest times," he says. "Even when I could barely move, I could still dance. Standing still was excruciating, but transferring my weight from one leg to the other was bearable."

One day, he decided to see how he would get on without medication. He has never looked back.

“I didn’t really notice much of a difference with the medication,” he says. “People diagnosed now would be offered different kinds of medication, such as disease-modifying medication, but I guess that wasn’t around when I was diagnosed.

“After a while it became really important to me to start challenging the condition, to take back control of my life.”

He started swimming and going out dancing, and stopped worrying about what other people thought. It's been five years since the last big flare-up.

“I just learnt to get on with life," he says."It’s easy to dwell on the pain and misfortune and to think ‘why me’. But, in the end, that's really quite futile. What’s important is to focus on all the things you enjoy. I swim regularly and enjoy a ramble in the woods, whereas 20 years ago I'd have thought 'Let's go for a walk' was the most ridiculous suggestion someone could make! The richer your experiences in life, the more you're distracted from the pain.

"And I still look good on the dancefloor, dancing like a robot from 1984!” 

Asthma

Introduction of Asthma...
Asthma is a common long-term condition that can cause a cough, wheezing, and breathlessness. The severity of the symptoms varies from person to person. Asthma can be controlled well in most people most of the time.

What is asthma?

Asthma is caused by inflammation of the airways. These are the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. When you come into contact with something that irritates your lungs, known as a trigger (see below), your airways become narrow, the muscles around them tighten and there is an increase in the production of sticky mucus (phlegm). This leads to symptoms including:
  • difficulty breathing
  • wheezing and coughing
  • a tight chest
Read more about the 
symptoms of asthma. A severe onset of symptoms is known as an asthma attack or an 'acute asthma exacerbation'. Asthma attacks may require hospital treatment and can sometimes be life-threatening, although this is rare. For some people with chronic (long-lasting) asthma, long-term inflammation of the airways may lead to more permanent narrowing. If you are diagnosed with asthma as a child, the symptoms may disappear during your teenage years. However, asthma can return in adulthood. Moderate to severe childhood symptoms are more likely to persist or return later in life. Although asthma does not only start in young people and can develop at any age. Read more about childhood asthma and how asthma is diagnosed.

What causes asthma?

The cause of asthma is not fully understood, although it is known to run in families. You are more likely to have asthma if one or both of your parents has the condition.

Common triggers

A trigger is anything that irritates the airways and brings on the symptoms of asthma. These differ from person to person and people with asthma may have several triggers. Common triggers include house dust mites, animal fur, pollen, tobacco smoke, exercise, cold air and chest infections. Read more about the causes of asthma. Asthma can also be made worse by certain activities, such as work. For example, some nurses develop asthma symptoms after exposure to latex. This is often referred to as work-related asthma or occupational asthma.

Treating asthma

While there is no cure for asthma, there are a number of treatments that can help effectively control the condition. Treatment is based on two important goals:
  • relieving symptoms
  • preventing future symptoms and attacks from developing
Treatment and prevention involves a combination of medicines, lifestyle advice, and identifying and then avoiding potential asthma triggers. Read more about living with asthma.

Who is affected?

In the UK, 5.4 million people are currently receiving treatment for asthma. That is 1 in every 12 adults and 1 in every 11 children. Asthma in adults is more common in women than men.
Symptoms of asthma...

The symptoms of asthma can range from mild to severe. When asthma symptoms get significantly worse, it is known as an asthma attack.

The symptoms of asthma include:

You may experience one or more of these symptoms. Symptoms that are worse during the night or with exercise can mean your asthma is getting worse or is poorly controlled. Talk to your doctor or asthma nurse about this.

Asthma attack

A severe asthma attack usually develops slowly, taking 6 to 48 hours to become serious. However, for some people, asthma symptoms can get worse quickly.

As well as symptoms getting worse, signs of an asthma attack include:

  • you get more wheezy, tight-chested or breathless
  • the reliever inhaler is not helping as much as usual
  • there is a drop in your peak expiratory flow (see diagnosing asthma for more information)

If you notice these signs, do not ignore them. Contact your GP or asthma clinic or consult your asthma action plan, if you have one.

Signs of a severe asthma attack include:

  • the reliever inhaler, which is usually blue, does not help symptoms at all
  • the symptoms of wheezing, coughing and tight chest are severe and constant
  • you are too breathless to speak
  • your pulse is racing
  • you feel agitated or restless
  • your lips or fingernails look blue

Call 999 to seek immediate help if you or someone else has severe symptoms of asthma.



Back pain

Introduction of back pain...
Back pain is a common problem that affects most people at some point in their life. It usually feels like an ache, tension or stiffness in your back. The pain can be triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly. Back pain is not generally caused by a serious condition and, in most cases, it gets better within 12 weeks. It can usually be successfully treated by taking painkillers and keeping mobile. Find out more about what can cause back pain.

Types of back pain

Backache is most common in the lower back, although it can be felt anywhere along your spine, from your neck down to your hips. You can find information on the specific types of back pain on the following pages: Read more about the symptoms of back pain.

Treating back pain

If you have back pain, you should try to remain as active as possible and continue with your daily activities. In the past, doctors recommended rest for back pain, but most experts now agree that being inactive for long periods is bad for your back. Moderate activity, such as walking or doing everyday tasks, will help your recovery. You can take painkillers, such as paracetamol or ibuprofen, if you feel the need to. Hot or cold compression packs may also help reduce the pain. You can buy compression packs from your local pharmacy, or a bag of frozen vegetables and a hotwater bottle will work just as well. Find your nearest pharmacy. Your state of mind can also play an important role. Although it can be difficult to be cheerful if you are in pain, research has shown that people who remain positive tend to recover quicker than those who get depressed. Some people choose to have manual therapy, such as physiotherapy or osteopathy, as soon as the pain starts. Private appointments cost around £40. For back pain that lasts more than six weeks (which doctors describe as chronic), treatment typically involves a combination of painkillers and either acupuncture, exercise classes or manual therapy. Spinal surgery is usually only considered when all else has failed. Read more about treating back pain.

When to see your GP

Most cases of back pain get better on their own and you do not need to see a doctor. However, you should visit your GP if you are worried about your back or you are finding it difficult to cope with the pain. Read more about how back pain is diagnosed. You should seek immediate medical help if your back pain is accompanied by:
  • fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling in the back
  • constant back pain that doesn't ease after lying down
  • pain in your chest or high up in your back
  • pain down your legs and below the knees
  • loss of bladder or bowel control
  • inability to pass urine
  • numbness around your genitals, buttocks or back passage
  • pain that is worse at night
These are known as 'red flag symptoms' and could be a sign of something more serious.

Preventing back pain

How you sit, stand, lie and lift can all affect the health of your back. See the back pain guide for how to sit, stand and lift correctly to avoid backache. Try to avoid placing too much pressure on your back and ensure your back is strong and supple. Regular exercise, such as walking and swimming, is an excellent way of preventing back pain. Activities such as yoga or pilates can improve your flexibility and strengthen your back muscles. Find out more about:
Treating back pain...

Treatments for back pain will vary depending on how long you have had the pain, how severe it is and your individual needs and preferences.

Short-term back pain

Most cases of back pain that last no longer than six weeks can be treated with over-the-counter painkillers and home treatments.

Painkillers

Paracetamol is effective in treating most cases of back pain. Some people find non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, more effective. A stronger painkiller, such as codeine, is also an option and is sometimes taken in addition to paracetamol.

If you also experience muscle spasms in your back, your GP may recommend a short course of a muscle relaxant, such as diazepam.

Painkillers can have side effects, some can be addictive and others may not be suitable, depending on your state of health. Your GP or a pharmacist will be able to give you advice about the most appropriate type of medication for you.

Read more about the medicines for back pain.

Hot and cold treatments

Some people find that heat - for example, a hot bath or a hot water bottle placed on the affected area helps ease the pain.

Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area is also effective. Do not put the ice directly on to your skin because it might cause a cold burn. Wrap the frozen pack in a wet cloth before applying it to the affected area.

Another option is to alternate between hot and cold using ice packs and hot compression packs or a hot water bottle. Hot compression packs can be bought at most larger pharmacies.

Sleeping position

Changing your sleeping position can take some of the strain off your back and ease the pain.

If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing a pillow under your knees will help maintain the normal curve of your lower back.

Relaxation

Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition can make things worse.

Research suggests that people who manage to stay positive despite the pain tend to recover quicker and avoid long-term back pain.

Read more about relaxation tips to relieve stress.

Keep moving

Most experts now agree that staying in bed, lying down or being inactive for long periods is bad for your back.

People who remain active are likely to recover more quickly. This may be difficult at first if the pain is severe, but try to move around as soon as you can and aim to do a little more each day.

Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.

There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity, and it can often distract you from the pain.

Exercise and lifestyle

Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress.

Regular exercise and being active on a daily basis will help keep your back strong and healthy. Activities such as walkingswimming and yoga are popular choices.

The important thing is to choose an enjoyable activity that you can benefit from without feeling pain.

Read more about preventing back pain.

Long-term back pain

If you have had back pain for more than six weeks (known as chronic back pain), your GP will advise you about which painkillers to take and recommend the treatments listed below.

  • Exercise - your programme should involve up to eight sessions over a period of up to 12 weeks. It will usually be a group class supervised by a qualified instructor. The classes may include exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
  • Manual therapy - there are different types of manual therapy including manipulation, mobilisation and massage, usually carried out by chiropractors, osteopaths or physiotherapists. If you choose a course of manual therapy, it should include up to nine sessions over a period of up to 12 weeks.
  • Alexander technique - is a method that teaches you how to eliminate unnecessary muscular tension from your body. The aim is to make you aware of any bad postural habits that you have while sitting or standing, as well as any inefficiencies in the way you move. You will learn how to improve the balance and alignment of your body.
  • Acupuncture - an ancient Chinese treatment where fine needles are inserted at different points in the body. Acupuncture has been shown to help reduce lower back pain. A course should include up to 10 sessions over a period of up to 12 weeks.

These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.

Nerve root blocks

A nerve root block is where a steroid or anaesthetic is injected into your back. If your back pain is caused by a trapped or inflamed nerve in your spinal column, the injection can help relieve the pain in your back, plus any associated leg pain.

To be effective, the injection needs to be made at exactly the right place in your back, so the procedure will be carried out under X-ray or CT guidance.

Facet joint injections

It is also possible to have anaesthetic or steroid injections in the facet joints. The facet joints are the joints that connect one vertebrae to another so that your spine is kept aligned. The joints are sometimes affected by arthritis. Facet joint injections are not always effective at relieving back pain.

Antidepressants

If the painkillers do not help, you will probably be prescribed tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended to treat depression, but they are also effective at treating some cases of persistent pain.

If you are prescribed a TCA to treat persistent back pain, the dose is likely to be very small.  See medicines for back pain for more information.

Counselling

If the treatments described above are not effective, you may be offered counselling to help you deal with your condition.

While the pain in your back is very real, how you think and feel about your condition can make it worse. Cognitive behavioural therapy (CBT) works by helping you to manage your back pain better by changing how you think about your condition.

Studies have shown that people who have had CBT later reported lower levels of pain. They were also more likely to remain active and take regular exercise, further reducing the severity of their symptoms.

Surgery

Surgery for back pain is usually only recommended when all other treatment options have failed.

Surgery may be recommended if your back pain is so severe or persistent that you are unable to sleep or carry out your day-to-day activities. The type of surgery will depend on the type of back pain you have and its cause.

For example, a procedure known as a discectomy may be used if you have a prolapsed disc. The discs are the circular, spongy tissue between the vertebrae that help cushion your spine. A prolapsed disc is where the hard outer membrane of the disc is damaged, causing the soft, jelly-like fluid inside to leak out.

A discectomy involves removing the damaged part of the disc through an incision made in your back. It is now possible for surgeons to carry out the procedure using a very small incision and a microscope or magnifying lenses to find the damaged disc. This minimizes the amount of trauma to the surrounding tissue, reduces the pain and discomfort in the affected area and results in a smaller scar.

Spinal fusion surgery is a less common surgical procedure where the joint that is causing pain is fused to prevent it moving.

As bone is living tissue, it is possible to join two or more vertebrae together by placing an additional section of bone in the space between them. This prevents the damaged vertebrae irritating or compressing nearby nerves, muscles and ligaments, and reduces the symptoms of pain.

Spinal fusion is a complicated procedure and the results are not always satisfactory. For example, you may still experience some degree of pain and loss of movement following surgery.

Before you agree to have surgery to treat back pain, you should fully discuss the risks and benefits of the procedure being recommended with your surgeon.

Other treatments

A number of other treatments are sometimes used to treat long-term back pain. However, they are not recommended by the National Institute for Health and Clinical Excellence (NICE) due to a lack of evidence about their effectiveness. They include:

  • low level laser therapy - where low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair
  • interferential therapy (IFT) - where a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body’s natural painkillers)
  • therapeutic ultrasound - where ultrasound waves are directed at your back to accelerate healing and encourage tissue repair
  • transcutaneous electrical nerve stimulation (TENS) - where a TENS machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) that are attached to your skin; the pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain
  • lumbar supports - where cushions, pillows and braces are used to support your spine
  • traction - where a pulling force is applied to your spine
  • injections - where painkilling medication is injected directly into your back