Pain – what pain?
Reproduced from Issue 105 of Arthritis Today
Ann C Papageorgiou, Research Nurse and Studies Co-ordinator
Most people reading this will have had back pain at some time in their life, and about a third will have experienced some back pain in the past month, but have probably not seen their doctor. Even so, about 6% of the population consult their general practice each year because of back pain…
What is back pain? For one person it might be an ache in the lower back after gardening, for another an acute pain that occurs for no apparent reason and lasts a few days, while for some it might be a persistent ache in the lower back which sometimes becomes more painful. The pain may be widespread, or focused on one point of the back, or radiate down either leg. It might last a few hours each day, be a single episode, re-occur at variable intervals, or be persistent.
In a study of back pain in the population, undertaken by arc Epidemiology Unit based at Manchester University, all the above were described. It was clear that each person with back pain has his or her own individual 'history' of symptoms.
As only about one in every seven cases of back pain will lead to a GP consultation, to find out the 'risks' for developing back pain it is necessary to study its occurrence in the community. This is what we did in our study of adults registered with two general practices in south Manchester. By sending out several thousand questionnaires, we were able to identify people currently free of back pain, and obtain information on potential risks for developing it. We then followed-up this group for twelve months to find out who developed back pain. This allowed us to identify risks both for developing the condition, and for it becoming chronic.
The results showed that people who had had back pain in the past or who had current pain in other parts of their body were more likely to develop back pain than those not reporting these symptoms. Respondents who said their health was generally good and considered themselves reasonably 'fit' were less likely to report back pain.
Physical activities, such as regularly lifting weights or standing/walking for prolonged periods at work, were a risk for women developing back pain, but not so for men. Psychological aspects also played a role, with people who felt distressed or who were dissatisfied with their work (or with not working) more likely to develop back pain. Similar factors also applied for the back pain becoming persistent, with additional risks being female gender, restricted movement of the spine and (to a lesser extent) pain radiating to the leg.
So, what are the implications of these findings and how can such diverse risks be explained?
First, back pain should not be considered simply in terms of a 'physical' injury to the back. Like all pain, it also effects how we feel and how we live our lives – the physical, emotional and social aspects of pain cannot be separated, and all need to be considered during treatment. This is reflected in the results of our study where dissatisfaction and distress were equally important risks for back pain as were regular lifting and a history of pain – and this is in people who had no current back pain at the start of the study.
Our study was one of several which provided information for a government advisory group on back pain which, in 1994, published guidelines for treatment.
So what should one do to treat back pain? The answer, in most cases, is to continue as normal. Yes, if the pain is persistent or associated with other symptoms, then seek medical advice – but this is not usually the case. The best advice is to stay active. In an acute attack, activities may have to be modified, and analgesics or heat used to ease the pain, but the sooner you get back to your usual activities and your 'normal' life pattern, the better both you – and your back – will feel.
Consider this scenario – for no apparent reason Jim's back starts to hurt. 'Ah', he thinks, 'pain means damage therefore I must rest my spine so it can get better'. So he rests in bed, avoids movement, takes pain killers, and after a few days is seen by the doctor who might prescribe further rest and advise some time off work.
However, this logic is based on a false premise: most people with back pain do not have any damage to their spine. The back is designed for movement – bed rest results in the muscles that support the spine becoming weakened. Stopping one's usual activities causes worry, and the inactivity can lead to distress when thoughts are focused on the pain and concern about the effect of the back 'injury' on one's life and future. And this stress and worry cause the pain to become worse.
We identified previous back pain as a risk for developing a new episode, and there are certain steps which can be taken to lessen the chance of back pain recurring, such a good posture, seating and lifting techniques. These are detailed in arc's booklet on back pain and in leaflets and posters at most health centres.
Following on from the results reported above we are undertaking a study of back pain in school children to identify what 'causes' the first episode of back pain to occur in young people. It was also clear from our results that back pain takes various forms and that, for some sufferers, the pain is not isolated to the lower back but is part of a wider pain syndrome. We are therefore continuing to study the causes and consequences of widespread pain in the population, from an approach that takes account of the physical, emotional, and social aspects of this symptom.
Meanwhile, if you develop back pain – think positive!
