Back Pain
An Information Booklet
What is in this booklet?
If you've got back pain, then you're probably reading this booklet because you want to get better and because you want to understand more about this problem. You are in good company because 4 out of 5 of us get back pain at some time. However, most bouts of back pain get better in a short time and simple painkillers are all that are needed. Getting back to normal activities is the best way to cope with back pain.
This booklet will be useful for people who have recently developed back pain, but it is primarily aimed at people who have more persistent ('chronic') back pain. It explains some of the causes of back pain and what can be done to help it and prevent it happening again. The technical words in italics are explained in more detail in the glossary at the end of the booklet.
What is the anatomy of the back?
The back is a complicated structure built around the bones of the spinal column (see Figure 1). The spinal column consists of 24 bones (vertebrae) sitting one on top of another. It sits on a large bony bowl – the pelvis – and is topped by the skull. The bones of the spine are connected to one another by the discs at the front and by the facet joints at the back. The discs help to absorb the normal loads on the spine and, with the facet joints, give the spinal column its flexibility (see Figure 2).
Figure 1. The spinal column showing the names of its different sections
Figure 2. Detail of the spinal column
(lumbar or lower back section)
The nerves of the spinal cord, which connect the brain to the rest of the body, run down a hollow channel in the spine (the spinal canal). Where the nerves pass out from the spinal column on their way to the muscles of the arms and legs they are known as nerve roots (see Figure 2). The bones of the back are also held together by tough bands called ligaments which, together with the spinal muscles, give the back its strength. The main muscles at the front and the back of the body are shown in Figures 3 and 4.
Figure 3. The muscles of the back
Figure 4. The muscles of the front (showing the 'abdominals')
What causes back pain?
Sprains and strains
Sprains of the back are a part of everyday life and the back is usually very good at taking these 'knocks'. Often you can't remember a sprain – an awkward movement may have caught your back 'off guard' and 'pulled' a muscle or sprained a ligament. Most cases of back pain are due to these sprains, which usually heal themselves within a short time. The body responds to this type of injury by trying to splint the painful area. This sets up muscle spasm or 'cramp' which may last several weeks and can be very painful. The affected muscle then tends to become weaker. It is therefore very important to exercise the affected muscle to reduce the spasm and try to improve its strength.
Back pain may be localized to the back but will sometimes be associated with pains in the leg – so-called 'referred pain' or sciatica. It is called sciatica because it affects the sciatic nerve which runs from the spine to the leg, and the pain, often accompanied by an abnormal feeling, is felt in the buttock, thigh and calf, and it can go all the way down to the big toe. Sciatica may be caused by muscle spasm following an injury, jolt or sprain to the spine. Normally this type of pain will last only for a short time and will ease with movement. However, sciatica may also be associated with a 'slipped' or 'prolapsed' disc. This is where the inner jelly of the disc bulges (or 'prolapses') through the outer fibrous ring. It can then press on a nerve and cause pain. When sciatica occurs as a result of a slipped disc then it is likely to be more persistent, lasting perhaps 6 weeks before it begins to settle down. If you notice weakness of the muscles in your leg, especially if you cannot pull your foot up towards you, or if you lose bladder or bowel control, you should see your doctor urgently.
Spondylosis
More persistent back pain can sometimes occur in association with arthritis of the facet joints and degeneration of the discs (sometimes called spondylosis or degenerative spinal disc disease). As we grow older the discs in the spine become thinner and the spaces between the vertebrae become narrower. Spurs of bone, known as osteophytes, may form at the edges of the vertebrae and the facet joints. Spondylosis often affects the lower back (lumbar spondylosis) or the neck (cervical spondylosis) (see arc booklet 'Pain in the Neck'). These changes may cause back pain, but often they do not. Some people, even those with badly worn discs and facet joints (which can be seen on x-rays), may experience no pain whatsoever.
Spinal stenosis
Occasionally back pain can be associated with pain in the legs which comes on with walking. This is called spinal stenosis (from the Greek word 'stenos', meaning 'narrow'). It is caused by narrowing of the spinal canal by osteophytes, a slipped (prolapsed) disc, and/or thickening of one of the main spinal ligaments called the ligamentum flavum. This causes squeezing ('compression') of the spinal cord or nerves. Typically, the pain will come on after just a few minutes' walking. The pain is generally felt in the thighs and sometimes in the lower leg. The pain usually settles after a few minutes' rest, and often people find that they suffer less discomfort if they walk a little stooped. It is usually associated with numbness or pins and needles in the legs. The symptoms often affect both legs but may affect one leg more than the other. Similar symptoms may be caused by a blockage or narrowing of the arteries in the legs (known as intermittent claudication) but this is a quite different condition, and requires different treatment, so your doctor will need to make sure that this is not the cause of your pain. A CT or MRI scan (see 'Should I have an x-ray or scan?' below) will show whether there is narrowing of the spinal canal or thickening of the ligament. Occasionally, spinal stenosis can result in a loss of bladder or bowel control; if this happens you should see your doctor straight away.
Other causes
Other causes of back pain are rare. They include:
- bone problems such as a fracture – often linked to thinning of the bones (osteoporosis) (see arc booklet 'Osteoporosis')
- infection
- a tumour
- inflammation, as in ankylosing spondylitis. In this condition the spinal ligaments may harden ('calcify'), forming new bone which may eventually cause the bones of the spine to join ('fuse') together (see arc booklet 'Ankylosing Spondylitis').
Should I have an x-ray or scan?
Generally speaking, if your back pain has come on recently then a plain x-ray of your back will not help to identify the cause of the pain. There are two main reasons for this. Firstly, most back pain comes from the soft tissues of the back (such as ligaments and muscles) and these cannot be seen on an x-ray. Secondly, as we get older we all have changes in the bones of the back which are due to normal ageing (spondylosis); these changes will be visible on an x-ray but, as suggested above, may not be causing the pain.
Occasionally a CT or MRI scan may help. These are normally only carried out when the doctor suspects a trapped nerve or stenosis (particularly if surgery might be needed) or one of the rarer causes of back pain such as a fracture, inflammation, infection or tumour. These tests require you to lie flat and perfectly still on a firm bed, which people with back pain may find difficult. With the MRI scan, you enter an enclosed tube which may be claustrophobic. They can take 40 minutes to perform, are expensive, and there is generally a waiting list.
Why does back pain become persistent?
Often it is not known why someone has persistent back pain. Even if a cause can be found (such as a slipped disc or arthritis of a facet joint) the pain may continue, sometimes long after the original problem has settled down.
Pain may at first cause you to avoid normal activities and movement. If your initial spell of back pain lasts a long time, lack of activity can cause the back muscles to become weak, and this reduces the ability of the spine to take further knocks. You may also lose confidence in your ability to resume your normal activities. This may affect your work, your social life and your personal relationships. Naturally, you may feel depressed and anxious in this situation and this can lead to further loss of confidence, frustration and anger, particularly if family members and the medical profession appear unhelpful or unsympathetic. If you are anxious or depressed as a result of the pain you may not feel like exercising, so your muscles become weaker still, and so it goes on. Physical and psychological factors can therefore combine to create two interconnected vicious circles (see Figure 5).
Figure 5. The ' vicious circles' of back pain
This can happen to anyone, and the longer it continues the harder it will be for you to recover your movement and confidence. The sections that follow explain what can be done to prevent, or break, this cycle of pain.
What can be done to help?
Most people manage back pain by themselves and recover without any lasting problem. But people who have had one attack of back pain are likely to have more. To help protect yourself from further problems you need to keep your back flexible and strong. You also need to think about prevention, such as learning the correct way to lift heavy objects (see 'What sort of things might make my back pain worse?').
If your pain has just come on and is severe it may help to take some painkillers (such as paracetamol or ibuprofen). These may be taken regularly for the first few days to reduce the overall level of pain, or they may be taken before activity so that you can exercise gently without it causing too much pain. (This is the same principle as someone with asthma using their inhaler before exercising in order to prevent exercise-induced wheezing.) Do not wait until your pain is very bad before you take the painkillers, and be careful with ibuprofen if you tend to get indigestion or have asthma. It will feel more comfortable to rest to begin with, but do not rest for more than a few days – at this point you should try and get back to normal activities and do some gentle exercises (see 'What back exercises should I do?'). Try and get back to work as soon as possible.
If the pain is severe or not getting better after a week or so, you should see a doctor, physiotherapist, chiropractor or osteopath who will examine you to make sure your back problem is straightforward. They may advise specific treatments. These may involve manipulation (see 'Would manipulation help?') or exercises and education about back pain. They may also recommend some form of pain relief such as the use of hot packs, acupuncture or TENS. You may need an injection into the back, particularly if you have persistent sciatica. Injections may be given into tender points, the space around the spine (an epidural injection) or the facet joints. Sometimes injections are done in the x-ray department to allow better placement of the needle.
There are some drugs which may help sciatica. Your doctor may recommend trying low-dose amitriptyline or drugs such as gabapentin or pregabalin. These drugs work by reducing nerve irritation and relaxing the muscles. They may need to be taken for 6 weeks initially and occasionally can be taken longer-term. As with all drugs, there can be side-effects, so they will not be suitable for everybody. Please discuss these drugs with your doctor.
Surgery is sometimes an option for spinal stenosis, but most doctors would recommend trying other measures first. These include physiotherapy – exercises which improve spinal and abdominal or tummy muscles may help the symptoms. A physiotherapist may give you specific exercises. Taking simple pain tablets (e.g. paracetamol) before activity may also help. If these measures do not improve your walking distance, other options include calcitonin injections or steroid injections into the back. However, none of these treatments have definitely been proven to help with spinal stenosis, and if your symptoms are very severe it may be necessary to consider an operation to relieve the pressure on the nerves or spinal cord.
Will I need an operation?
Only a few people with back pain need surgery (probably less than 1% of all cases of back pain). Occasionally a large piece of slipped disc can press on the nerves of the spinal cord and cause bladder problems (such as difficulty in passing or controlling urine). In this rare situation you need urgent surgery to remove the disc fragment. For severe cases of sciatica, surgery may sometimes be needed to relieve the pressure on the nerve. For less severe disc disease, it is usually better to let nature 'take its course' and, in most cases, the condition will improve without surgery. As mentioned above, surgery may also be needed for severe spinal stenosis.
What can be done for persistent back pain?
If your back pain lasts for many months you may need help to cope with it. The answer may be a pain management programme which aims to teach you how to control, and live with, your pain. Understandably, people avoid situations which make their back pain worse, such as certain positions and activities. However, in persistent back pain, the pain does not necessarily indicate damage or inflammation (see 'Why does back pain become persistent?'). Education, therefore, plays an important part in the pain management approach, and will include a full explanation of the physical and psychological factors contributing to a person's pain. It is usually possible for people with back pain to exercise and improve their fitness. This may be a slow process, but it helps people regain their physical confidence so that they can do more despite their pain. Specific exercises also help to strengthen the back muscles that have become weak with lack of use.
Pain management programmes are generally outpatient group sessions, often led by physiotherapists, but some hospitals offer residential in-patient programmes. These programmes include education, exercise, coping strategies and the use of medication, and are delivered by a team including doctors, nurses and physiotherapists. Psychologists are also usually part of the team as they can explain why you might suffer psychological distress (often felt as anxiety and depression) and how you can cope with this.
What back exercises should I do?
Exercise is the most important way that you can help yourself. Any form of continuing pain will mean that you stop moving so well. This leads to your muscles wasting and this will make your back weaker and more easily tired. So you need to restore the strength and flexibility in your back. The body needs strong back muscles to work as a shock absorber for jolts and knocks which are part of daily life. If you look at Figure 3 you will see that the back is covered largely by muscles.
Your job is to:
- regain flexibility
- build up muscle strength and stamina
- improve your general fitness.
You may be advised about specific exercises by a physiotherapist. Even when your back is sore you can make a start without putting too much stress on your back. Also, remember that your back may feel sore after the first few days of exercise – this is normal so don't let it put you off (it may help to take some painkillers before exercising on these days).
The exercises fall into three main groups:
- Stretching exercises These include exercises for the back and leg muscles (see Figure 6).
- Strength, stamina and stabilizing exercises These include exercises for the back, stomach and leg muscles (see Figure 7).
- Exercise for general fitness This includes any exercise which makes you out of breath, but choose something you enjoy such as swimming, cycling or keep-fit classes.
Figure 6. Stretching exercises
Figure 7. Strength, stamina and stabilizing exercises
Any exercise is easier if you increase it gradually and if you do it along with someone else. Group exercise classes may run in your local hospital or sports centre. It is very important to exercise regularly. Just as it is advisable to clean your teeth twice a day to prevent damage and to keep your mouth healthy, so it is important to exercise your back daily. Research has not shown that any particular exercise is better than another, or that you need to exercise for a specific length of time, but the general principle is that the more effort you put into the exercise the better. Regular exercise not only keeps your back fit but also helps to strengthen bones, and will release endorphins which are the body's own painkillers. If you are overweight, exercise will also help you to lose weight, which will reduce the strain on your back.
If you have arthritis in other joints you can still do appropriate back exercises, but you may need different exercises – in this case it is best to take advice from a physiotherapist.
How active should I be?
Generally, the more active the better. Unless your pain is very severe or causing bad sciatica you should try to stay mobile. Do some specific back exercises every day and some general fitness exercise as well (see 'What back exercises should I do?'). Remember, specific exercises keep your back supple and strong, and general exercises help you feel good about yourself and help release natural painkillers (endorphins).
What sort of things might make my back pain worse?
Everyone is different but there are a number of situations which are likely to make your back pain worse:
- Sitting too long in one position, especially in a poor position, e.g. slumped in a chair (see Figure 8).
- Driving is often a situation you can't avoid, but make sure the seat is adjusted correctly for your height (use a cushion to sit on if necessary). You should also maintain your lumbar curve, which is the curve that forms the hollow in the lower part of your back, and take regular breaks when on a long journey (see Figure 9). Some people find the Alexander technique helpful for improving posture and reducing muscle tension.
- Lifting heavy weights incorrectly. Avoid lifting heavy objects if you can. If you must do it, always keep the weight close to your body and bend your knees. In practice if you find you are holding your breath as you lift or push something then it is too heavy.
- Spending long periods bending over, such as when gardening. Use special gardening tools: see 'What aids and appliances are available?' Also see arc booklet 'Gardening and Arthritis'.
- Worrying. Try to avoid stress and too much worry – tension can often make your back pain worse. You may want to try relaxation classes. Talk to others and make a plan about things which worry you.
- Not taking regular exercise and doing your back routine!
Figure 8(a). Bad posture when seated at a desk
Figure 8(b). Good posture when seated at a desk Adjust the chair or table, and position of the computer screen, so that you don' t have to slump. Have your work in front of you, not to the side. Consider trying a tilted stool.
Figure 9(a). Bad posture when driving
Figure 9(b). Good posture when driving Use cushions to experiment if you need a higher seat or support in the small of your back.
Do corsets help?
Corsets are still commonly prescribed by doctors, but they don't usually do the job they are meant to do (which is to restrict your movement and carry some of the weight of the upper body). People can become dependent on corsets. It is better to strengthen your back by doing exercises rather than relying on corsets.
Would manipulation help?
Manipulation may help to get rid of a spell of back pain – it is most often done by chiropractors and osteopaths but also by physiotherapists and some doctors. There are different types of manipulation which vary from using the hands to make gentle movements of the spine to more vigorous movements using the limb as a 'lever'. Ask your GP or consultant, or see 'Useful addresses'.
Should I get a new bed?
Many people with back pain prefer a firm surface to lie and sleep on as they feel the back is better supported in this way. Many so-called orthopaedic beds provide this level of firmness. However, you may be able to get the same effect just by putting a board under your mattress. Look around carefully and try things out before buying a new bed. Remember that the mattress should be soft enough to mould to the shape of your body at the shoulder, waist and hip, but firm enough to support your spine. A mattress that sags will allow the spine to bend and will tend to strain your back.
What aids and appliances are available?
If you have long-standing back pain you may need to change how you do things to avoid making the pain worse. For example, as mentioned earlier, gardening can make you bend over for long periods of time. You should make changes such as using long-handled gardening tools. You can also buy back supports to lean against (not corsets!) for use when sitting at home, at work or in the car. Most towns have a centre or shop where these aids can be tried and purchased, for example Disabled Living Centres (see 'Useful addresses'). You could also ask for advice from an occupational therapist who will help you to change the way you do things and advise on equipment or supports. See also arc booklet 'Gardening and Arthritis'.
Do any special diets help?
If you are overweight you should consider a weight-reducing diet because of the extra strain that your weight puts on your leg joints and back. Exercise will help you to lose weight. You will also be advised to stop smoking (as this may be an independent cause of back pain), so you should take extra care to prevent the weight gain that often follows (see arc booklet 'Diet and Arthritis').
Should I give up work?
The answer to this question depends on your back pain, your age and your job. During a spell of back pain, we recommend that you try to stay at work or get back to work as soon as possible. If your job involves heavy physical work you may need a period of lighter duties – talk to your foreman or boss. Statistics show that the longer you are off work the less likely it is that you will return.
People who work – particularly in physical jobs – may struggle if they develop persistent back pain. This is recognized by the Department for Work & Pensions. Your local Disability Employment Adviser (contacted via the local Jobcentre or Jobcentre Plus office) can arrange work assessment and retraining. If you are disabled due to back pain and wish to carry on working then either the Disability Employment Adviser or the Employment Medical Advisory Service may be able to help. The help they can provide will vary from person to person but they can, for example, provide necessary equipment to make it easier for you to do your job. A period of rehabilitation may help you get back to work (see 'What can be done for persistent back pain?').
What will the future hold for me?
Everyone is different, so it is impossible to describe a typical person with back pain. Don't forget that this is a common problem, so many of the people around you have also experienced back pain. As mentioned earlier, people who have had one spell of back pain tend to get more – these spells may become more frequent and last longer. It may be possible for you to prevent this happening. And even if the back pain does become persistent it may be possible to avoid the disability associated with it – see 'Summary: What can I do to help myself?' below.
Are there any self-help groups?
BackCare is the parent organization for a number of local self-help groups which meet on a regular basis. Activities vary from meetings with a speaker to social activities and education and pain management, sometimes with exercise classes. The Pain Relief Foundation provides audiotapes dealing with back pain. (See 'Useful addresses'.) You should be able to get support, education and help from the Expert Patient Programme – contact your Primary Care Trust (or GP's surgery) for details.
Summary: What can I do to help myself?
- Remember, don't panic! Most spells of back pain will get better.
- Don't rest for too long after the start of the pain – 2–3 days at most. Too much rest is bad for you – your muscles become flabby, your bones become thin (lose density), and it becomes even harder to get going again.
- Gradually increase your normal activities, avoiding painful movements at first.
- Do your back exercises regularly (see 'What back exercises should I do?') and without fail twice a day in the same way as you clean your teeth twice a day. This is your chance to fight back. You won't notice a dramatic change but over time your back will become stronger and you'll feel more confident about it. You will be able to lift again within the safety limits recommended.
- Take up some additional form of exercise (what, more?! Yes, more! – we suggest you change your way of life). Keep-fit classes, exercise bikes and swimming are all good exercises.
- Stop smoking. It makes exercising difficult and it may make back pain worse.
Glossary
Acupuncture – a method of obtaining pain
relief which originated in China. Very fine needles are inserted,
virtually painlessly, at a number of sites (called meridians) but
not necessarily at the painful area. Pain relief is obtained by
interfering with pain signals to the brain and by causing the release
of natural painkillers (called endorphins).
Alexander technique – a method of teaching
bodily awareness and reducing unwanted muscle tension. Lessons are
given by qualified teachers who will assess and advise on such things
as your standing and seating posture and your patterns of movement.
CT/MRI scans – computer tomographic (CT)
scans use x-rays, and magnetic resonance imaging (MRI) uses magnets.
Both involve the scanner taking a 3D picture of your body. You will
have to lie very still for a few minutes as the pictures are taken.
Both scanners can make you feel a bit claustrophobic, so you should
tell the radiographer if this worries you. MRI scanners are noisy,
but you will be provided with ear mufflers!
Disc – the piece of gristle in between the vertebrae (the bones of the spine) which allows your spine to be flexible. A 'slipped' disc occurs when the central jelly (nucleus pulposus) of the disc bulges or prolapses through the outer fibrous ring (annulus fibrosis). It can then press on a nerve and cause pain. The disc as a whole doesn't actually slip out.
Facet joints – the small joints between the vertebrae
which allow the spinal column to move. The facet joints are at the
back of the spine. Sometimes these can be the cause of back pain.
Ligaments – tough fibrous bands which are attached
to the vertebrae and give stability to the spine. They also restrict
spinal movements.
Osteophytes – overgrowths of new bone at the edges
of osteoarthritic joints. Spurs of new bone can alter the shape
of the joint and may press on nearby nerves.
Pelvis – the bones of the pelvis form a bowl shape
which is connected to the spinal column at the sacroiliac joint
and to the leg bones at the ball-and-socket joints of the hips.
The pelvis contains vital organs such as the bladder and rectum
and, in women, the womb.
Sciatica – pain felt in the leg due to irritation
of the sciatic nerve, a major nerve running from the spine to the
leg. The pain is usually felt in the buttock, thigh and calf but
can go all the way down to the big toe.
Spinal column – the name given to the backbone. It
consists of the vertebrae, stacked one upon another, and the discs
linked together by ligaments and muscles.
Spinal cord – a cord which runs down the spinal canal
and contains the nerves which connect the brain to all the other
parts of the body. The nerve fibres are surrounded by several protective
layers and pass through the vertebrae (the bones of the back). The
spinal cord and the brain together form the central nervous system.
Spondylosis – normal changes in the spine which occur
as we grow older and are frequently seen on x-rays.
TENS – transcutaneous electrical nerve stimulation.
A TENS machine is a small battery-driven device. Small pads are
applied over the painful area and the low voltage stimulation produces
a pleasant tingling sensation. This can relieve pain by interfering
with pain signals to the brain.
Vertebra (plural 'vertebrae') – one of the bones which make up the spinal column.
Useful addresses
The Arthritis Research Campaign (arc)
PO Box 177
Chesterfield
Derbyshire S41 7TQ
Phone: 0870 850 5000
www.arc.org.uk
As well as funding research, we produce a range of free information booklets and leaflets. Please contact the address above for a list of titles or, on this website, see Publications for People with Arthritis.
Arthritis Care
18 Stephenson Way
London NW1 2HD
Phone: 020 7380 6500
Helpline (freephone): 0808 800 4050
www.arthritiscare.org.uk
Offers self-help support, a helpline service, and a range of leaflets on arthritis.
BackCare (The Charity for Healthier Backs)
16 Elmtree Road
Teddington
Middlesex TW11 8ST
Phone: 020 8977 5474
Helpline: 0845 130 2704
www.backcare.org.uk
Helps people manage and prevent back pain by providing advice, promoting self-help, and funding scientific research into back care.
British Chiropractic Association (BCA)
59 Castle Street
Reading RG1 7SN
Phone: 0118 950 5950
www.chiropractic-uk.co.uk
Can supply details of chiropractors in your area.
The British Pain Society
3rd Floor, Churchill House
35 Red Lion Square
London WC1R 4SG
Phone: 020 7269 7840
www.britishpainsociety.org
Chartered Society of Physiotherapy
14 Bedford Row
London WC1R 4ED
Phone: 020 7306 6666
www.csp.org.uk
Disabled Living Centres Council
Assist UK
Redbank House
4 St Chad's Street
Cheetham
Manchester M8 8QA
Phone: 0870 770 2866
www.assist-uk.org
Contact Assist UK for details of your nearest Disabled Living Centre(s). A full list of addresses is available on the Assist UK website.
Disabled Living Foundation (DLF)
380–384 Harrow Road
London W9 2HU
Phone: 020 7289 6111
Helpline: 0845 130 9177
www.dlf.org.uk
Employment/benefits
Your Jobcentre or Jobcentre Plus office can put you in touch with
your local Disability Employment Adviser. For information on benefits
you can contact the Benefit Enquiry Line on (freephone) 0800 882200.
Employment Medical Advisory Service (EMAS)
To find your local office, see the telephone directory under 'Health
& Safety Executive'. The address and phone number should be
available in all workplaces. Alternatively, you can get this information
from:
HSE Infoline, Caerphilly Business Park
Caerphilly CF83 3GG
Phone: 0845 345 0055
www.hse.gov.uk/contact/index.htm
General Chiropractic Council (GCC)
44 Wicklow Street
London WC1X 9HL
Phone: 020 7713 5155
www.gcc-uk.org
The regulatory body for chiropractors in the UK; can also provide details of chiropractors in your area.
General Osteopathic Council
176 Tower Bridge Road
London SE1 3LU
Phone: 020 7357 6655
www.osteopathy.org.uk
Can supply details of osteopaths in your area.
NHS Expert Patients Programme
For details of courses in your area, visit:
www.expertpatients.nhs.uk
Pain Relief Foundation
Clinical Sciences Centre
University Hospital Aintree
Lower Lane
Liverpool L9 7AL
Phone: 0151 529 5820
www.painrelieffoundation.org.uk
Carries out research into relief of chronic pain and provides information for the public.
Society of Teachers of the Alexander Technique (STAT)
1st Floor, Linton House
39–51 Highgate Road
London NW5 1RS
Phone: 020 7482 5135
www.stat.org.uk
Can supply a free list of practitioners of the technique.
Information on drugs
Separate arc leaflets are available on many of the drugs used for arthritis and related conditions. We would recommend that you read the relevant leaflets for more detailed information about your medication.
