Back pain

Back pain differs from person to person. Back problems can be felt as a dull ache or, contrastingly, a sharp shooting pain, depending on the cause of the problem.

Symptoms of back problems can also include muscular spasms and leg pain, usually from sciatica. This can cause numbness, pins and needles or weakness in the leg.

Although rare, if you suffer from back pain or sciatica associated with the following, you should seek medical advice immediately:

• Difficulty urinating
• Loss of control of your bladder and bowel
• Numbness around your saddle area (around genitals and buttocks)
• Weakness in both legs or unsteadiness on your feet
• Severe unremitting pain that gets worse over time

It's challenging to attribute back pain to one specific cause. For some people it can occur as part of the ageing process or from degenerative conditions such as arthritis, which are more common in older patients. The stiffness associated with arthritis can reduce the movement of your spine and may cause you to experience pain. However many people have arthritis and don't experience any back problems.

Predictors of back pain are most commonly related to comorbidities, which means if you have other health issues or you aren't very fit or active, you are more likely to have a bad back. The most effective way to avoid back pain is to maintain a good level of exercise.

There are also specific conditions which can cause back pain. These include:

A herniated cervical disc

Also known as a slipped disc, this condition develops when one of your vertebral discs moves out of place or bulges. The disc then pushes against the nerves or the spinal cord.

Sciatica

This is the term used to describe a pain down your leg, which is often caused by pressure on a nerve in your spine, perhaps due to a 'slipped disc'.

Spinal stenosis

This is where the space in the centre of the spine (spinal canal) narrows. As a result, the nerves become trapped in the spinal canal or where they leave the spine, causing weakness or pain in your legs.

Scoliosis

Scoliosis is an abnormal sideways curvature of the spine. As a result, the spinal column (backbone) twists, causing the ribcage to rotate. If your scoliosis is severe it can cause significant back pain.

Your back pain specialist may talk to you about the three main types of back pain, which are:

• Non-specific back pain
• Mechanical low back pain
• Pathological back pain

Non-specific back pain

Non-specific back pain is a class of back pain where, even after imaging (such as an MRI scan), the specialist cannot find a cause.

Mechanical low back pain

The second class is mechanical low back pain from the anatomical structure of the back. In most cases, the pain is from the discs, but it may also be from the joints and nerves.

Pathological back pain

The third type of back pain is pathological and seen less often than the first two classes. Primary tumours originating in the spine or secondary tumours due to metastasis (tumours spreading into the spine) are the causes. Fractures that happen because of osteoporosis are another cause.

Dr Sanjay Kuravinakop, a consultant in chronic pain management and anaesthetics, spoke to us about specific areas of the back that cause pain and answered some of the most common questions people have about back pain.

Lower back pain causes

Dr Kuravinakop says: "The most common cause of lower back pain is disc degeneration. At any given point, about 45% of back pain is due to disc disintegration. The second most common cause of low back pain is joint osteoarthritis."

If you have lower back pain on the left or the lower right side, and the pain doesn't extend below the knees, it's usually caused by one of these two things.

Is lower back pain a sign of cancer?

Although patients often worry that lower back pain might be cancer, it's very rare.

Dr Kuravinakop explains the signs: "The pain would be beyond what you'd expect and the patient would usually have associated symptoms. These red flags include weight loss, general health changes, and appetite loss. To reassure you, most patients do not have cancer; the pain is mechanical. However, if you have a strong history of cancer in the family or have had cancer and developed back pain, you should go to a consultant and ask for an investigation."

What can cause lower back pain in a woman?

Back pain during pregnancy is one of the main reasons for lower back pain in women. The increased weight of the baby, adding to the stress on your spine, causes mechanical changes that result in pain. Hormonal changes also cause laxity in the joints (loosened joints).

"The pain usually settles down after pregnancy, but if it persists despite exercises to strengthen the core muscles, it needs investigation and management," says Dr Kuravinakop.

What does Covid back pain feel like?

There are anecdotal reports from people who say existing back pain worsens during recovery from Covid-19, but it usually improves over time.

"When you have back pain due to disc degeneration, like arthritis, there is also inflammation," explains Dr Kuravinakop. "Covid increases inflammation; hence the pain generally worsens."

What is middle back pain a symptom of?

Middle back pain is rarer than low back pain because it's a more protected spinal area than the cervical or lumbar region.

Dr Kuravinakop says: "The causes of back pain are the same - discs and joints - but there is another joint in the vertebra called the costovertebral joint that could be causing it. But it's generally not a common complaint we see."

Should I worry about upper back pain?

Upper back pain is often postural, but if it includes the neck, shoulder and arm, it could be referred pain from the neck.

"A back specialist has various tools in their armoury such as exercises to teach posture management and stretches," says Dr Kuravinakop. "If you follow them, the pain can be reasonably well controlled."

Only after we've tried more conservative treatments and found they don't work, will we recommend invasive or surgical options.

Can back pain cause chest pain?

Dr Kuravinakop says: "Chest pain is usually unrelated to back pain; it's probably more local, affecting muscles between the ribs or the structure inside the ribs. Very rarely, if a slipped disc in the back presses on the spinal cord or a nerve, patients can get chest pain across both sides to the front of the chest, but it's a rare occurrence."

If you are worried about your chest pain and think it might be related to your back, a back pain specialist, musculoskeletal expert or surgeon can rule this out.

The good news is that many back problems are not serious and won’t require surgery.

Many cases of back pain can be effectively treated at home with postural changes or by applying heat or ice and taking pain relief such as paracetamol, aspirin or ibuprofen.

If the pain continues for more than 72 hours and isn’t improving despite self-help, then physiotherapy can relieve soft tissue injuries, muscle tension, and postural problems. Our physiotherapists can help you to manage your pain and can also easily refer you to a consultant if needed.

Exercise can prevent back pain by keeping it moving and supple. If you have back pain, it's good to continue with activities that promote cardiovascular fitness, such as taking the dog for a walk, but the best exercises are those that strengthen the body's core.

The core refers to the abdominals, back, and gluteal muscles that support the spine. Swimming, yoga, pilates and tai chi can all help to strengthen your core and are all beneficial for people with back pain. Try to find types of exercise that you enjoy doing and make it a part of your regular routine.

Pain during exercise

If the pain is significant and you cannot do intense exercises, an excellent place to start is pilates or yoga with an instructor who understands back pain and can guide you gently.

"You should start with low-intensity exercises done regularly over some time - only then will you start reaping the benefits," explains Dr Kuravinakop.

Getting a firm diagnosis can not only help to resolve your issue but can also help you return to your normal activities as soon as possible.

Dr Kuravinakop says: "A lot of back pain is managed using non-interventional, non-medicine treatments, such as exercises, manual therapy, and understanding what the pain is. However, if the pain persists beyond that, it will need further treatment and investigation."

You should see a doctor quickly if you have the following signs, which indicate a severe problem (red flags):

1. Trauma, fracture or osteoporosis fracture
2. Sudden onset of pain, and pain down the legs
3. Numbness of the lower limbs and loss of control of the bowel or bladder

If you have - or suspect you have - any of the above, you should seek medical attention immediately.

Many problems can cause back pain, and the right specialist depends on the underlying cause.

For example, a consultant rheumatologist might see you if you have osteoporosis. However, if a slipped disc causes back pain, you might seek treatment from an orthopaedic spinal surgeon. Depending on your type of back pain, your consultant could also be a chronic pain management specialist or a spinal neurosurgeon.

"If it's the cervical region or cancer, I would send a patient to a neurosurgeon. If it's the lumbar spinal region, I will send them to an orthopaedic surgeon," says Dr Kuravinakop.

The best way to find out which consultant is right for you is to speak to your consultant or a physiotherapist, who can identify the specialist best suited to you. If you aren't yet seeing anyone about your back pain, you could call us and speak to one of our dedicated advisors, who should be able to point you in the right direction.

You can expect our back pain specialists to explore your medical history carefully and do a thorough (though non-invasive) physical examination. They will also assess how significantly back pain impacts your quality of life - for example, mood, sleep and relationships.

Based on the examination and your symptoms, they will form a probable diagnosis, but this needs to be confirmed with further investigations and tests.

Diagnostic tests for back pain

If your medical history or personal circumstances indicate cancer, osteoporosis or trauma, the most common diagnostic tests your consultant will send you for are X-rays and MRI scans to identify fractures or tumours.

However, if you have a history of sciatica, MRI is the primary screening tool. An MRI scan shows soft tissue, discs, joints, bones, fractures and the level of nerve impingement.

Once they establish the cause of the pain, your consultant will discuss a treatment plan to help you to manage, improve or even eliminate your back pain. This plan is tailor-made for you and will only be confirmed with your agreement.

Your consultant will work with a multidisciplinary team to diagnose your condition and come up with a personalised treatment plan for your back pain. Your specialist will then go through the treatment options with you at length, making sure you understand them all in full before making a decision.

Dr Kuravinakop says: "We offer three strategies - short-term relief, intermediate-term relief and long-term management. Short-term and intermediate-term help patients by reducing the pain and allowing them to focus on long-term plans, including exercises, stretches and learning different coping strategies to deal with the pain.

"Long-term strategies are important. Medication, injections and exercise can reduce your pain, but they work over time and often when used in combination. By doing that, we allow patients to focus on exercising the core muscles, learning stretches and doing them more effectively once they have relief."

At Circle Health Group, our approach to back pain is multidisciplinary. Our pain specialists are linked to private physiotherapists who can guide patients on correct exercising and stretching. You might be referred to other experts, such as a psychotherapist. They deal with the psycho-social wellbeing of patients affected by pain and the overall impact on their quality of life.

The behaviour-based treatments for rehabilitation by a psychotherapist could involve acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT).

Physiotherapy

When back pain is non-specific, your GP or consultant will most likely refer you to a physiotherapist first, as the problem is probably mechanical, such as muscular problems or disc wear and tear.

The registered physiotherapists at Circle Health Group provide non-surgical therapies for issues such as sciatica and poor posture. Consultants may also send you to the physiotherapy team after surgery, for rehabilitation.

Dr Kuravinakop explains that you need to see physiotherapy as a long-term commitment to lifestyle change. He says: "People often come to me after six sessions with a physiotherapist to say nothing has happened. This is because those six sessions do not improve strength. The aim is to provide guidance on what exercises to do and how to do them. You must then practise regularly."

Acupuncture

There is some evidence that acupuncture can help relieve back pain in certain instances. In a recent survey called Joint Pain Matters, we found that 66% of people who had tried acupuncture for back pain said they experienced an improvement in pain levels.

Pain medicine

The focus for back pain is typically non-pharmacological treatments such as manual therapy with a physio and exercise. But if someone has neuropathic pains, such as sciatica (impingement of the nerves in the spine), they may be prescribed anti-neuropathic drugs to help it.

Usually, a combination of medications works better than solo medication, such as paracetamol interspersed with ibuprofen anti-inflammatories. Opioids are not recommended; if you are on them, your consultant will likely encourage you to come off them and replace them with exercise and coping strategies.

Steroid injections for back pain

The next step in back pain treatment is steroid injections. These can give you some relief if you take over-the-counter painkillers, exercise, and stretch regularly, but you still have pain.

Inflammatory back pain, such as arthritis, can respond well to steroid injections and provides pain relief for six to eight months. Afterwards, the consultant will discuss with the patient any further treatments that might benefit them.

Modulatory treatments

Radiofrequency treatments give longer-term benefits for those with back pain using special equipment in our operating theatres. The machine generates a radiofrequency current that modulates (burns) the tiny nerves that carry pain signals from the joint.

If a significant nerve like the sciatic nerve is being treated, your consultant may suggest pulsed radiofrequency (PRF) that modulates the nerve and gives patients better relief that lasts longer.

Surgery for back pain

Lastly, someone might benefit from surgery if they had tried medication and injections or there are changes in the spine, like a slipped disc impinging the nerve so far that injections are less helpful, or a scan detects cancer or metastasis.

Dr Kuravinakop says: "If the leading cause is the discs and there's been prolonged degeneration (the discs have shrunk in height, and there's significant inflammation), you may benefit from spinal fusion.

"If a patient has a slipped disc-related impingement of nerve routes and significant sciatica, then most commonly a discectomy or lumbar decompression is the surgery offered."

Undergoing an operation for back pain is not something to be taken lightly. You should only consider it once a specialist has identified the root cause of your pain.

When you go private with us, you can expect:

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

At Circle Health Group, our friendly team is always on hand to provide information, advice and reassurance. If you're experiencing back pain and would like more information about possible treatment options, you can book an appointment online or give us a call on 0141 300 5009

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Exercises for back pain, NHS Inform
2. Mechanical pain , Spine Health
3. Spinal Anatomy Center, Spine Universe
4. Arthritis, NHS.uk
5. Low back pain, BMJ
6. Spinal fusion facts, WebMD