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Back pain

Fast access to treatment for back pain in Worthing

Back pain is an extremely common condition that most of us will have at one time or another during our lives. Due to our modern lifestyles, working conditions and activities, degenerative back problems are widespread and can lead to back pain at almost all ages.

Most back pain does not have an underlying cause. But if the pain persists or is associated with other concerning signs, a back pain specialist should be consulted. They will help you understand the cause of your pain, how to reduce it and determine if there is a need for any intervention such as surgery.

Back pain comes in two main forms — acute and chronic. Acute back pain is discomfort that has come on recently, and should last less than 12 weeks before it has gone away. In contrast, chronic back pain can last much longer.

This page will look at the causes, symptoms and treatments of back pain. It will also explore the treatment options for back pain at Circle Health Group hospital, Goring Hall Hospital in Worthing.

At Goring Hall Hospital, you can rest assured that you will receive the very best care.

When you visit us for the first time, you will be seen by one of our spinal specialists who will take the time to really get to know you and understand your pain.

If you require further treatment, our state-of-the-art operating theatres and modern aftercare facilities will ensure that your stay is safe and comfortable.

It is helpful to understand a little about how the spine is formed, as damage or degeneration in any of the structures can lead to pain.

The spine is formed from bones called vertebrae. These are stacked on top of one another in a column.

The column is divided into five parts:

  • Cervical vertebrae: the neck
  • Thoracic vertebrae: the upper back
  • Lumbar vertebrae: the lower back
  • Sacral vertebrae: the rear of the pelvis
  • Coccygeal vertebrae: the tailbone

Between the vertebrae are shock-absorbing structures called intervertebral discs. These stop the bones of the spine from rubbing together when moving. Wear and tear or excessive force can damage these discs.

The spine is also held in alignment by ligaments connecting the bones together and by tendons that connect to muscles that stabilise and allow movement.

Down the middle of each vertebra is a channel called the spinal canal. The spinal cord runs through this — a large gathering of nerves running down from the brain.

At each level, nerves leave the cord and exit the spine, travelling out to all parts of the body to allow movement and returning with sensory information.

Back pain is an extremely common symptom for people to have. It most often occurs in the lower back, a condition which is referred to as lumbago.

Back pain can also be found at any other point along the spine, from the neck to the tail bone, with the most likely causes changing depending on location.

The pain may be present all the time or come and go. Some people may find that their symptoms are worse first thing in the morning and then improve over the course of the day. Other people may find that their discomfort is worsened by activity, exercise or particular movements.

For many people, there are no other symptoms than pain. Some, in addition to their pain, experience nerve-related symptoms which can include tingling or numbness in hands, feet, arms or legs.

Back pain red flags

There are a few ‘red flag’ symptoms which suggest that you should urgently seek specialist attention. These include:

  • Numbness in the genitals or buttocks
  • Loss of bowel or bladder function
  • Pain associated with weight loss
  • Severe pain after trauma to your back
  • Chest pain associated with your back pain
  • Back pain and a high temperature
  • Back pain that is much worse at night

Call 111 or see your GP if your back pain is accompanied by any of the above.

When you see a back pain specialist, they will take a detailed history of your pain. Questions that you might be asked about your pain could include when it started, whether it is there all the time, if there are any associated symptoms like numbness and if anything makes it better or worse.

Your back pain expert will take time to find out what effect your back pain has had on your life, especially if it is preventing you from doing any daily activities.

Another important part of the conversation will be finding out about your medical history and determining if any conditions you have or medications you take might be contributing to your pain, or if they will affect the treatment that you could receive.

Once the specialist has asked all the questions they need to, they will examine you and your back. This will involve feeling the bones of your back and asking you to perform movements.

The examination is also likely to include your nervous system to ensure that the nerves exiting your spine have not been damaged. To do this, your sensation, movement and reflexes in your limbs may be checked.

The specialist will then take the time to explain what the possible diagnoses are, talk through any further investigations and treatment that might be suggested, and answer any questions that you might have.

There are a number of different investigations that a back pain expert might recommend to diagnose the cause of your back pain.

For some people, after taking a full history and examination, their specialist might decide that no further investigations are needed to come to a diagnosis. For others, some of the following tests might be performed:

Blood tests

Blood tests might be performed to help determine a cause for the pain. They might also be conducted to check the function of various organs, look for evidence of infection, or to see whether your blood clots normally (especially if you are taking blood-thinning drugs).

Nerve tests

Nerve conduction studies (NCS) and electromyography (EMG) are tests to determine how well your nerves are working and how well your muscles respond to the messages from your nerves. Your specialist may request these tests to look for injuries to the nerves coming from your spine.

X-ray

A simple x-ray image can sometimes be the first investigation for back pain. It can see some changes to the bones of the spine from injury or disease.

CT scan

A CT scan produces advanced x-ray images that can look at your back from all angles. They will show conditions involving the bones of the spine and some significant nerve problems.

MRI scan

This technique involves using magnetism to take detailed images of the body. It is especially good at looking at soft tissues including nerves.

There are many different causes of back pain, and if you have symptoms, the only way to be confident of your diagnosis is to consult a back pain expert.

Fortunately, most back pain is due to overuse, poor posture or lifestyle factors. These are often termed to be ‘musculoskeletal’ in origin. This would very rarely require surgery or other interventions.

Treatment usually consists of changing the factors that lead to the back pain in the first place, coupled with physiotherapy exercises to strengthen the back and rehabilitate damaged tissue.

There are a number of other causes of back pain:

Congenital causes

These are issues that you are born with. They can involve differences in the shape of the spine, for example:

  • Scoliosis: an abnormal curve to the spine
  • Lordosis: the spine curves backwards
  • Kyphosis: the spine curves forwards

Other congenital causes of back pain can include differences in how the spine forms in the womb, such as spina bifida.

Injuries to the back

Injuries to the back can occur in all manner of situations, from sporting mishaps to significant car accidents. Some injuries are mild, such as sprains, and will resolve themselves with reduced activity, painkillers and perhaps physiotherapy.

More significant injuries such as fractures might require interventions such as surgery to correct.

Any injury to your back that does not resolve quickly, or that causes new nerve symptoms (such as in the ‘red flags’ section above) should prompt you to see an expert urgently.

Degenerative changes

Over time, particularly with an active lifestyle, wear and tear can accumulate in the spine. Pain from these changes tends to come on gradually, and people may well have dealt with their discomfort for some time before seeking help.

Elements of the spine that can have degenerative changes include:

  • Intervertebral discs, which can lose their height, flexibility and shock-absorbing ability
  • Facet joints at the back of the spin, which can have arthritis leading to pain and stiffness

Nerve and spinal cord issues

The spinal cord itself is well-protected within the spine, but some conditions can compress the cord leading to nerve symptoms.

These can include growths in the spine, fractures to vertebrae, herniated discs and a narrowing of the canal that the cord sits in.

Many of these conditions come on slowly, but a sudden onset of nerve symptoms means that you should seek expert help urgently.

Nerves can also be compressed as they exit the spine leading to pain and sometimes loss of function.

Causes of back pain not from the spine

There are a number of causes of pain which may feel like it is from your spine, but which may actually relate to general medical conditions or diseases inside the abdomen. These can include:

  • Kidney stones: solid lumps that form within the kidneys and can then be passed down the tubes to the bladder. The pain can often be felt in the back
  • Endometriosis: where tissue from the womb is found in other locations, most commonly throughout the abdomen
  • Fibromyalgia: a condition that can lead to generalised pain and fatigue
  • Pregnancy: the hormonal changes can relax ligaments, leading to back pain

For back pain, the priority is to rule out serious problems that might require an intervention such as surgery.

Fortunately, in most cases, the cause is not concerning and the treatment in these situations does not require an operation.

This can only be determined with the help of a back pain expert who can listen to your history, examine your back and use the correct investigations to make the diagnosis.

Management of new (acute) back pain

The treatment of new back pain, once it has been shown not to have a concerning cause, consists of:

  • A reduction in activity levels to a manageable level (but not complete bed rest)
  • Short term use of medication, including painkillers, muscle relaxants and topical (on the skin) pain relief
  • Careful exercises, often with expert physiotherapy input, to build up the strength of your back and correct harmful postures and movements

Chronic back pain

Pain is usually said to be chronic when it lasts longer than 12 weeks. The management of chronic pain may well be led by a specialist pain doctor. Common treatments for chronic pain include:

  • Over-the-counter pain relief such as paracetamol and ibuprofen
  • Stronger prescription-only medications including tramadol, codeine and other opioids
  • Specialist nerve pain medications such as gabapentin
  • Guided exercise to ensure that you keep active
  • Psychological support to aid your mental health

Advanced treatments for back pain

Some back pain, especially chronic back pain, may need specialist interventions to help. These are often performed by spinal specialists or pain specialists. Some of these treatments might be:

  • Epidural injections, where pain-relieving or anti-inflammatory medications are injected into the epidural space
  • Facet joint injections, which involve injecting medications around the facet joints of the spine
  • RF ablation, which uses strong radio waves from the end of a needle to destroy a small amount of the nerve tissue which is transmitting pain signals

Surgery for back pain

Surgery is an advanced option for back pain and is only suitable for a select few patients.

Most people with back pain do not need surgery. It is usually performed where there is damage to nerves or where the problem causing the pain is likely to get worse without an operation.

Operations of the spine can be ‘open’ where a cut is made on the skin that is long enough to be able to see and operate on the area of the spine that requires it.

Another option is ‘minimally invasive’ spinal surgery, where only small cuts are used, and the spine is either directly operated on or a small camera called an endoscope is used to visualise the spine.

Operations on the spine for back pain can include:

  • Vertebroplasty and kyphoplasty: to correct damage to the vertebrae
  • Spinal laminectomy: to decompress the spinal cord
  • Discectomy: to remove portions of an intervertebral disc, usually if it is pressing on a nerve
  • Foraminotomy: enlarging the space that a nerve has to exit the spine if it is being compressed

The most important thing with back pain that is not getting better is to see a specialist. This will help you to ensure that the cause of your pain does not need intervention.

Once both you and your specialist are happy that there is no serious cause for your pain, there are a number of things you can do to help your back.

Education

Learning about how your back works, and what you can do to take care of it, can help you avoid the actions and situations that lead to pain.

Exercise

Your back is not meant to be kept still. Taking part in exercise regularly, to whatever level you feel you can, has a host of benefits.

From looking after your heart to better mental health, exercise can help with many things — particularly the condition of your back.

Even if you are already experiencing back pain it is important to keep moving. You can quickly become deconditioned and find that your ability to get back to the activities that you love will be greatly hampered by a long period of inactivity.

Maintain a healthy weight

If you are over your ideal weight this can have a number of effects on your back. Most notably the excess weight puts significant extra strain on the tissues of your back, particularly the discs and joints.

If you are having back pain, you may find that losing weight will greatly improve your symptoms. If you want extra support in your weight loss journey, speak to your specialist who will be able to advise you and signpost you to services that can help.

Make work adjustments

For many of us, particularly those who have a sedentary job, our work environments can present a considerable risk to our back health.

Sitting for long periods, using uncomfortable chairs, equipment at the wrong height, and heavy lifting can all lead to back pain and injury.

Occupational therapists are experts who can advise you in making work-related adjustments to help you cope with back pain and reduce the chance of repeat injury.

Stop smoking

Stopping smoking has a huge range of health benefits, including for back health.

Giving up may allow you to be more active, engage in physiotherapy exercises for your back, and will have considerable benefits if you go on to need an intervention like surgery.

Back pain is a very common symptom that most of us will have during the course of our lives.

However, if it does not improve quickly, interferes with your daily life, or is associated with symptoms of nerve injury, a back pain specialist should be consulted.

If you choose to visit one of the specialists at Goring Hall Hospital, you can be assured that you will be at the centre of all discussions and decisions about how to treat your back pain.

We ensure reassuringly fast access to our services, usually within 48 hours.

Goring Hall Hospital in Worthing is home to experts in back pain management.

If you choose to visit us, you can be assured that our multidisciplinary team will take the time, not only to fully understand and diagnose your back pain, but also take the time to understand you.

Through the whole process, they will ensure that you feel safe, cared for and listened to. All treatment plans will be focused on your wishes and what you see as the optimal outcome.

Our spinal specialists are experts in diagnosing and managing all types of back pain — from benign causes that do not need intervention, to more serious causes that require surgery.

Specialist pain management and procedures

Our centre has experts in minimally invasive spinal surgery, which uses smaller incisions and can result in a quicker return to normal life.

Goring Hall Hospital has specialists in advanced pain management, with long experience in managing complex and chronic back pain. A multidisciplinary team of doctors, nurses and physiotherapists will care for you.

Specialist pain management procedures, including nerve blocks, epidural injections and facet joint injections can be performed.

Goring Hall Hospital is a friendly, safe and comfortable environment for your back pain treatment.

From the moment you first meet your back pain specialist in one of our clean, modern consulting rooms you will be treated with dignity and care.

Our diagnostics and imaging department has access to the latest technology to ensure a rapid and accurate diagnosis of the cause of your back pain, including X-ray, ultrasound, CT and MRI.

The hospital is situated within extensive beautiful grounds with views out to sea.

Our three main theatres are staffed by a highly-skilled healthcare team to ensure the very best outcome for you. After your operation, you will wake up in our recovery unit before heading to one of our 52 private rooms.

Our 24-hour nursing and medical staff will ensure that you get back to full health safely and quickly.

How to find us

Goring Hall Hospital can be found at Bodiam Avenue, Goring-by-Sea, West Sussex, BN12 5AT.

Located on the sunshine coast of Worthing, the hospital serves Worthing, West Sussex and further afield — offering a wide range of services from dermatology to orthopaedics.

Book an appointment online today or call us at 01903 863926. We can help you find the cause of your discomfort and get you back to doing what you love.

Specialists offering Back pain

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Mr Rafid Al-Mahfoudh

Consultant Neurosurgeon and Complex Spine Surgeon

MBChB, European certificate in Neurosurgery, FRCS (SN)

Goring Hall Hospital

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Dr Simon Dolin

Pain Management Consultant

MB BS, FRCA, PhD, FFPMRCA

Goring Hall Hospital

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Dr Kaushik Sanyal

Consultant Rheumatologist

FRCP(UK), MRCP Rheum(Lon) MRCP(UK) MSc Rheum(Lon) European Certificate in Rheumatology (Switzerland) EMBA(HealthCare Management),PGC Medical Leadership (Lon), PGDMLS, MAcadMed, MBBS

Goring Hall Hospital

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Mr Tony Elias

Consultant Neurosurgeon

MS, MCh, FRCS (Ed), FRCS (Glasg), FRCS (Surgical Neurology)

Goring Hall Hospital

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Dr Stephan Weber

Consultant in Pain Management

State Exam Med (Berlin), MD (Berlin) FRCA (Lon) FFPMRCA (Lon)

Goring Hall Hospital

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Mr Shuaib Karmani

Consultant Spinal Surgeon

BDS, FDSRCS, MBBS, FRCS, MSc FRCS (Trauma & Orth)

Goring Hall Hospital

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