Acute Back Pain in Adults

Most back pain is due to a sprain, strain, or minor tear to a ligament or muscle in the lower back. The pain usually develops suddenly and is often called ‘mechanical’ or acute back pain.

Symptoms
Pain can range from mild to severe. The pain is typically eased by lying down, and made worse by movements of the back, coughing, sneezing bending or attempts to lift. Pins and needles, or numbness in part of a buttock or leg sometimes occur (but tell a doctor if these develop). This indicates that the lumbar spinal nerves are compressed as they leave the spinal cord and the spinal column. Urgent medical advice should be sought in respect of such symptoms.

Most episodes of back pain ease quickly – within a few days or a week. Symptoms have either gone, or are very much eased, within four weeks in 3 out of 4 cases. In about 9 out of 10 cases the symptoms have gone or eased within six weeks. However, it is not uncommon to have further bouts of pain some time in the future. Also, it is common to have minor pains ‘on and off’ for quite some time after a severe bout of pain. In a minority of cases the symptoms last for several months or longer. Such chronic episodes of back pain may be eased and altered by physiotherapy, adjustment of seated or standing posture or other therapies.

Back pain with any of the following symptoms may indicate a more serious problem and are amongst those which should be reported at an early stage to a doctor.
• Weakness of leg, or of feet muscles.
• Problems with your bladder, the passing of urine or bowels.
• Weight loss.
• Pain that develops gradually, and slowly becomes worse.
• Unremitting severe pain

Treatment
Treatments include the following modalities. Although surgery is sometimes necessary for severe cases or those in which the nerves to the legs, bladder or bowels are affected, non-surgical treatments is the mainstay of treatment. General advice includes:

• Continue with normal activities as much as you reasonably can. This may not be possible at first if the pain is severe. However, get back into normal activities as soon as you are able. As a rule, don’t do anything that causes a lot of pain. But, you will have to accept some discomfort when you are trying to keep active. In the past, advice had been to rest until the pain eases. It is now known that this was wrong. Chronic (persistent) back pain is more likely to develop if you rest rather than keep active. At bedtime, sleep in the most naturally comfortable position. Some people find a firm mattress to be the most comfortable. Alternately a small towel roll or pillow under the small of the back often helps.

• Painkillers, analgesics and NSAID’s. It is best to take painkillers regularly. This is often for several days or weeks until the symptoms settle. This is better than taking them ‘now and again’ just when the pain is very bad. Taking them regularly may prevent pain from getting severe, and help you to exercise and keep active. Paracetamol is often sufficient to ease the pain. Additional NSAID’s (Brufen, Ibuprofen, Diclofenac, Voltarol etc) can alleviate pain, muscle spasm and joint inflammation. If necessary a doctor can prescribe these drugs or if appropriate something stronger if needed.

• Physical treatments. Some people visit a physiotherapist, chiropractor or osteopath for manipulation and/or other physical treatments. Whether such treatments work is often debated. However many patients happily attest to their effectiveness. However, physical treatments may quicken recovery in some people, particularly if the onset of the pain was recent, or chronic symptoms have resulted in stiffness and muscle spasm.

Treatment may vary, and you should see a doctor if the symptoms are severe. Symptoms to watch out for include but are not limited to the following:
• the pain becomes worse.
• the pain is unremitting and severe.
• weakness of muscles, numbness of skin or altered sensation occurs or if any alteration in bladder or bowel function is noted.
• The symptoms change or new symptoms develop.
• the pain persists beyond 4-6 weeks.

© OrthopaedicsOpinionOnline 2011 www.OrthopaedicOpinionOnline.co.uk
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