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Find out more about the causes of back pain, as well as the benefits of back pain treatment at The Alexandra Hospital
Back pain can affect your lower back, your mid-back, or your upper back. Lower back pain is the most common form of back pain.
On this page, we review the causes, symptoms, and treatments for back pain. We also provide an overview of the treatments and services available for back pain at Circle Health Group’s The Alexandra Hospital in Manchester.
Back pain isn’t usually serious, and most of the time it will go away with time.
However, if you experience other additional symptoms and the pain doesn’t go away with regular painkillers, you may need to seek medical attention and find out the underlying cause.
Dr Ankur Saxena, MBBS MRCSEd FRCS, is a consultant neurosurgeon who specialises in spinal disorders at The Alexandra Hospital. He explains:
“The most common pain in the spine is in the lower back, and the most common cause is due to muscular problems. [This] could be something simple, like a sprain, which can come on either by excessive muscular activity, light injury or sometimes just abnormal posture sustained over a long period of time, like prolonged sitting.”
However, in rare cases, Dr Saxena explains, the cause may be something more serious like an infection or rarely, a tumour.
For this reason, he notes, “if there is pain in a person’s spine, particularly lower back, which is getting worse with time and which is not helped with simple conventional treatment, like painkillers, light exercise [...], or if the patient has other symptoms, like localised tenderness, temperature, weight loss [...], then the patient needs to seek medical attention to look into other causes [and] relevant clinicians should organise an investigation.”
Lower back pain is also called lumbago, and it affects the lumbar area of your spine. The lumbar region is between your hips and the beginning of your ribcage. Usually, this pain comes with tension in your muscles and the inability to move as much as you’d like or as you used to.
The lumbar region supports a lot of the weight of the upper back and is made of five vertebrae. In-between these vertebrae there are spinal discs — soft pads that are meant to act as shock absorbers when you move your body.
Vertebrae are held in place by ligaments and muscles, and they attach to the spine with the help of tendons.
Your spinal cord also holds the roots of 62 nerves, which control body movements and send signals to the brain.
When a clear, specific cause cannot be found for your back pain, this is called ‘non-specific’ back pain.
Common causes of non-specific lower back pain include:
Causes for specific lower back pain include:
Your consultant will help you get to the bottom of your back pain and establish the underlying cause.
Sometimes, mid and upper back pain have clear, specific causes, such as:
Other times, the cause is not as specific. In these cases, mid- to upper back pain may be caused by:
Less common causes include arthritis, a herniated disc, fibromyalgia, or compression fractures as a result of osteoporosis.
Sciatica is a specific cause of lower back pain and is usually due to a slipped disc. A slipped disc puts pressure on the sciatic nerve.
In sciatica, the leg pain may be worse than the back pain. It might travel through the buttocks and along a certain nerve, or it may come with other symptoms like tingling or numbness.
Sometimes, however, back pain is not caused by the spine. This is called “referred” pain, explains Dr Saxena. “Technically, any organ in the abdomen can cause referred pain to the lower back,” he says.
Some of the abdominal causes for referred pain include:
However, Dr Saxena stresses that the vast “majority of back pain is caused by either the muscles or the skeletal structure of the spine.”
“But you can have other pathologies, especially pelvis-related, where females are affected more than males,” he explains.
Some possible causes of back pain in women are:
Dr Saxena also adds that postmenopausal women who are not taking hormone replacement therapy (HRT) are at an increased risk of osteoporosis, which may cause back pain.
However, he stresses that “by and large in our practice, from a spine point of view, we see almost an equal incidence of spinal pain [in both sexes].”
Sometimes your back pain may be due to a combination of a few of these different factors.
“The old theory used to be that if patients have severe back pain, they were advised bed rest,” Dr Saxena explains. “But now, the recent understanding is that bed rest is actually more harmful to patients. So, [now we] encourage the patients to mobilise as much as they safely can.”
You can treat acute back pain at home with over-the-counter painkillers. These include medicines that are also anti-inflammatory, like the non-steroidal anti-inflammatory drug (NSAID) ibuprofen, or painkillers that only relieve the pain, such as paracetamol and aspirin.
Dr Saxena recommends that people take painkillers as quickly as they can. “If you take even a painkiller or two initially when the pain starts, then your recovery is likely to be faster than if you try to be brave and hope that you could ride it out without any intervention.”
Anti-inflammatory painkillers are very good for muscular pain, explains Dr Saxena, but you need to be mindful of their side effects. These include:
Special caution is also necessary if you have asthma, and you have never taken ibuprofen before.
“One of them is a GP-led urgent care centre, for patients in acute pain who are struggling to get relief and must seek urgent medical attention,” say Dr Saxena.
Here, highly experienced GPs will “take a full history and perform a detailed examination of the patient and arrange for necessary investigations,” he says.
Depending on the outcome of these examinations and tests, the GP may refer the patient to a spine specialist or a physiotherapist. These specialists are usually widely available in the hospital and can quickly provide assistance if there is an urgent condition that needs addressing.
The second way is by self-referral. Patients can directly book to see a spinal specialist — some specialists may require a GP referral, Dr Saxena says, while others like himself happily see patients without a GP referral.
To make sure the underlying cause of your back pain is not something more serious, your consultant will ask you a series of questions about your medical history. This is to accurately diagnose the cause of your back pain and establish the course of your treatment.
They may perform an imaging test, such as:
They may also ask you to take some standard blood tests and sometimes a urine test.
“The good thing about The Alexandra Hospital is that we are one of the biggest spinal centres in the private healthcare sector in the country. So [there is] a spinal specialist available on most days to see a patient if the need arises,” Dr Saxena says. He adds that same-day appointments are also available, depending on how busy the clinic is that day.
The spinal specialist, much like the GP, will ask a series of questions about the patient’s medical history and occupation. They will also perform a thorough examination, including imaging tests and any other specific investigation they feel is necessary.
“The advantage of seeing the spinal specialist is that more spine specialists are able to read and interpret the scans by themselves [...] if there is something urgent.”
Eventually, the specialists will catch up with the radiologists to make sure they haven’t missed anything, Dr Saxena adds.
In addition, Dr Saxena explains, the hospital’s specialists are used to performing “slightly higher risk surgeries” compared to other private healthcare institutions. This is due to the fact that the hospital has a 24/7 critical care unit and is one of the largest private hospitals and spinal centres in the country, with a “large spinal and neurological presence.”
“Because of the sheer number of surgeons and the volume of patients we see here, you've got almost a dedicated spinal list [of specialists] every day of the week.”
“So that helps, along with the fact that our nurses, our physiotherapists, our theatre staff, everybody is so used to dealing with spinal pathology that we've developed quite a good expertise with a range of problems, from simple spinal problems to quite complex ones.”
After the consultant makes a diagnosis, they can devise a management and treatment plan.
This, explains Dr Saxena, may consist of conservative treatment such as:
Surgery is sometimes also recommended as a treatment. However, Dr Saxena emphasises, surgery just for back pain is quite rare.
“The majority of [spinal surgeries] are to relieve compression of the nerve or to add to the stability of the spine.”
The Alexandra Hospital specialists “have expertise in a lot of minimally invasive surgical procedures, [such as] endoscopic surgical procedures, and in open spinal surgical procedures” for a range of conditions such as sciatica or stabilisation surgery.
The Alexandra Hospital is a national centre of excellence for endoscopic surgery, Dr Saxena adds, and there are very few centres in the country that offer this kind of surgery for sciatica.
However, it is also common for the pain to come back. A bit over 70% of people who have had back pain will experience it again within a year.
It is less likely that these recurrences are as severe as the first episode of pain, and most people do not need to see their healthcare provider for these.
Back pain usually goes away in a few days or weeks, sometimes on its own, even without treatment. However, in some cases, the pain becomes chronic.
Doctors classify back pain into three main categories:
About 20% of people with acute back pain go on to develop chronic back pain.
We also offer flexible payment options, should you pay for the treatment yourself.
If you have private health insurance, you can also use it to pay for care at The Alexandra Hospital.