An integrated approach to back pain
About eight million people suffer back pain lasting for more than a month each year. 1.1 million people are disabled by it. 13% of unemployed people say that back pain is their reason for not working. Patterns of the condition are affected by age - with young people tending to have short episodes, and older people more susceptible to chronic pain.
Who gets back pain?
Almost everybody gets back pain at some time, but some groups are more at risk of chronic illness. Office workers who repeatedly use the telephone without a headset, cashiers, train drivers and car drivers who travel more than 25,000 miles a year are often affected. A significant minority of schoolchildren also suffer back pain, and those who have symptoms as children are much more likely to have pain as adults.
‘Frozen peas wrapped in a teatowel’
A stretched ligament or trapped nerve can be very painful with little outward sign that something is wrong. X-rays only pick up signs of radical damage that affects the alignment of the bones. Hence pinpointing exactly what is wrong is tricky, and may not help with treatment. The interventions recommended by the NHS therefore concentrate on very practical approaches - including keeping active when the pain isn't acute, and home-made hot and cold compresses. They also suggest that Alexander technique, osteopathy, chiropractic or physiotherapy may be of some help to some people.
Who stays ill?
Back pain is a condition that lends itself to an integrated approach, because there is no one magic bullet to treat it. It can be part of a network of chronic conditions too: obesity coupled with back pain can leave sufferers in a vicious cycle: the extra weight put strain on the back, the back pain makes it harder to exercise, leading to further weight gain. Bad food can be a factor in other ways - without the right nutrients to help the body to mend, minor damage can linger for months and gradually turn into a permanent problem.
Psychological and social factors complicate the picture. The worst pain doesn't necessarily translate into the worst outcomes, and people who are able to carry on with their lives rather than retreating into bed do better in the long run. Hence doctors are less likely to prescribe bed rest now, and more likely to offer painkillers and encourage the patient to keep moving.
There are signs that social isolation, problems at work or overprotective responses to lesser pain can lead to chronic, disabling outcomes.
Back pain, then, isn't the relatively straightforward mechanical illness that it may first appear to be. In the first month the 'take some painkillers and keep moving' approach will resolve the situation for many. But for longer standing back pain looking at the patient's whole circumstances can be vital to prevent an acute situation turning into a chronic one.
An integrated approach to back pain needs to incorporate, among other things, individual exercise patterns and posture, nutrition, work and personal life balance, weight and psychological factors. Not everyone will get completely well, but the right combination of treatment can prevent people from feeling cut off from the world by an illness that began as a slight inconvenience.
