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BACK PAIN - The Facts

Who gets back pain?

Back pain affects 4 out of 5 adults at some stage in their lives[1]. Nearly 5 million working days were lost as a result of back pain in 2003-04. This means that on any one day 1% of the working population are on sickness leave due to a back problem[2].

It is the number 2 reason for long term sickness in the UK, and in manual labour jobs, back pain is the number one reason[3].

Types of Back Pain

Back pain is classified in two main ways:

1) Non-specific back pain – where the pain is not caused by serious damage or disease, but by sprains, muscle strains, minor injuries or a pinched or irritated nerve . Most backache (85-90%) will be so-called simple low back pain (or 'mechanical low back pain') . Non- specific back pain is the most common cause of back pain. This will vary with posture, activity, time and treatment.

Causes of non–specific back pain:
The structure of the spine is very complex. Back pain can be triggered by everyday activities at home and at work, or by poor posture. These are a few of the simple triggers:

  • bending awkwardly 
  • lifting, carrying, pushing or pulling incorrectly
  • slouching in chairs
  • standing or bending down for long periods
  • twisting
  • coughing
  • sneezing
  • stress
  • over-reaching
  • driving in a poor position
  • driving for long periods without taking a break
  • poor patterns in the way that you move
  • sleeping in an awkward position

However, in many cases our posture and the patterns of movement that we undergo also play a role in helping us to develop back pain. So whilst some people have a fall or injury which may be the cause of their problem, others may just wake up with back pain and have no idea what has caused it. Many people may also experience occasional episodes of back pain as a result of the normal ageing process of the spine, which can temporarily disrupt the normal function of the back.

2) Specific back pain – pain that is associated with an underlying health condition or damage to the spine.
Causes of specific back pain include:

  • sciatica – a condition caused by a nerve in the back (the sciatic nerve) being irritated or compressed
  • slipped disc – where one of the discs of the spine splits and the gel inside leaks out
  • ankylosing spondylitis – a condition where the joints at the base of the spine become inflamed
  • osteoporosis - condition that affects the bones, causing them to become weak and fragile and more likely to break (fracture).
  • Infection  - in the bones of the spine
  • Tumour – a single  growth in the bones of the spine or in the nervous tissue in the spine , or the spread of cancer into the bones of the spine can cause back pain.

Non – specific back pain can also be classified according to how long the symptoms last. For example:

  • acute back pain – the pain does not last longer than six weeks
  • chronic back pain – the pain lasts for more than six weeks[4]

However, there are several definitions of chronic back pain. For instance the British Pain Society define chronic back pain as continuous, long-term pain of more than 12 weeks or after the time that healing would have been thought to have occurred in pain after trauma or surgery.



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Cost of Back Pain on the NHS

The estimate cost in terms of health care is £1.6bn a year [Back Care, 2008] and the estimated annual cost to the UK employers and the economy is £5bn[5].

Outlook

How people experience back pain can vary considerably between individuals. Some people have minor episodes of acute back pain before making a full recovery, whilst  others have long periods of mild to moderate back pain that are interrupted by periods of severe pain, which makes them unable to do their normal daily activities.

Psychological and social factors play an important role in the expected outlook for back pain, particularly for chronic back pain. Those people who think positively, are less stressed and are generally  enjoying life tend to make a faster recovery than those who have a history of depressive illness and are unhappy with one or more aspects of their life.

Risk factors


Risk factors for back pain include:

  • being 20 to 50 years of age – backache mostly affects young and middle-aged adults , though it can affect all ages
  • being overweight or obese – extra body weight placing more strain on the bones, muscles and joints of your spine
  • smoking – tobacco smoke may damage the tissue of the back , but also that smokers tend to have unhealthier lifestyles than non-smokers
  • suffering with poor health
  • being pregnant – the postural changes occur when pregnant along with the loosening of the ligaments as a result of hormone changes. Also the excess weight of carrying your baby can place additional strain on your back the strength in the back is reduced or your endurance is reduced
  • previous history of back pain
  • the long-term use of medications that are known to weaken bones, such as corticosteroids
  • stress –either work stresses, marital, financial etc.  It is believed that people who are under stress tense the muscles in their back, which could trigger an episode of back pain
  • depression – acts as a contributory factor to back pain. When stressed you don’t feel like exercising or taking care of yourself properly.
  • occupational factors - having a job (or regularly taking part in an activity) that involves a large amount of lifting, twisting, sitting down or repetitive motion can increase your risk of developing back pain.

The cause of your back pain will determine the best type of treatment. For more information please see treatment for back pain.

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Content by Jane Morris - connect with me on Google+


References:
[1]  Back Care, 2008
[2]  HSE, 2005

[3]  DWP, 2002, Back Health at Work. HSE 2005, Department for Work and Pensions, 2002.
[4]  NHS Back Pain 2010
[5] Maniadakis A, Gray A. The economic burden of back pain in the UK. Pain 2000;84:95-103

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