Managing low back pain

What is acute low back pain?

It is pain felt in the lower back that lasts for a short time, that is less than three months.

Most people experience pain in their lower back at certain stages of their lives. In most cases, it will get better in several weeks even without treatment. However, this varies from person to person. Such a pain may happen again over time and may progress to chronic low back pain, which is back pain that persists for more than 3 months.

What causes acute low back pain?

Most of the time the pain is due to muscle strains. It is rare for the pain to be caused by a serious medical problem. For about 95 per cent of the cases, the pain can be managed effectively even when the specific cause is unknown. In fact, 90 per cent of the patients recover within six weeks.

What should I do when I have acute low back pain?

If your pain bothers you, it is important to see your doctor, working with him or her to manage your pain. Staying active will play an important part too.

Seeing your doctor

Medical history and physical examination are needed to check for any serious medical condition that may be associated with your pain, although this is rare.

Additional investigations such as x-rays and blood tests are not needed in the majority of the cases of acute low back pain. Such tests do not help with your pain or your ability to move your back.

It is normal to worry about the cause of your pain and the impact it may have on you. Talking to your doctor or specialist about your concerns can be helpful. You will usually find that there is no serious cause and that there are ways to relieve your symptoms.

The goal of the consultation is to help you find ways to manage your pain and return to your usual activities.

Anyway, most people find that the pain eases off over a short period of time as healing occurs. Pain-relieving measures can help you cope with your symptoms while nature takes its course. For example, your doctor can prescribe you with medications like paracetamol, anti-inflammatory medicine, and muscle relaxants.

Stay Active!

Your pain may make it difficult for you to carry out your usual activities, and you may even want to rest completely.

However, it is important to resume normal activities as soon as possible. Staying active helps to prevent long-term problems.

When do I need to see a pain specialist?

You should see a pain specialist if:

1. The pain persists, becoming chronic if lasting more than three months;
2. The pain is associated with nerve root pain that is characterised by:

• Pain that travels to the foot on one side of the leg
• Numbness in the leg
• Pain in leg that worsens by bending over or coughing and straining

The specialist will perform a complete initial assessment that typically includes a medical history and physical examination. He or she may ask you certain questions as well as conduct strength and movement tests on you to check for serious underlying conditions, such as fractures, tumours, infection and severe nerve damage. Sometimes, other investigations may be needed to arrive at a diagnosis.

What treatment would I receive?

A multi-pronged approach will be needed to manage chronic back pain.

Medication

Many patients benefit from medication, which relieves low back pain and reduces inflammation or muscle spasms. Specific medications may also be prescribed for the treatment of the nerve pain.

Physiotherapy

Various physical treatment modalities will help relieve the pain. Specific exercises may be prescribed to strengthen your back muscles. You should actively perform the exercises regularly to receive optimal benefit.

Interventional therapy

This is used to diagnose and treat the cause of the pain arising from different spinal conditions. It mainly involves injections administered in a procedure suite using guidance from x-rays.

Such a procedure lasts for about thirty minutes and is performed under local anaesthesia with mild sedation. You will be fit to go home within two hours after observation.

If necessary, you may also be referred to an Orthopaedic surgeon for a surgical assessment.

Written by Dr Tan Kian Hian, Associate Consultant, Pain Management Centre, Singapore General Hospital
This article was first appeared in The Graduate magazine, a National University of Singapore Society (NUSS) publication