Grow Youthful: How to Slow Your Aging and Enjoy Extraordinary Health
Grow Youthful: How to Slow Your Aging and Enjoy Extraordinary Health

Back pain

What is back pain?

Incidence of back pain

Causes of back pain

The usual sequence of events

Prevention / remedies / treatment for back pain

Tips for back pain

References

What is back pain?

Back pain can come on suddenly (acute) or persist as chronic pain for years, depending on its cause. It can be a dull ache, or sharp and piercing; be quite specific in location or widespread; it may radiate into the limbs; and it may include weakness or numbness.

Back pain can be described anatomically: neck (cervical), upper back (thoracic), lower back (lumbar) or tailbone (sacral).

Regions of the spinal column

The spine is a complex network of nerves, discs, joints, muscles, tendons and ligaments, all of which are capable of producing pain. Being the largest nerve channel in the body means that it has the capacity to generate and carry a high level of pain. Pain can radiate to the arms and legs through the large nerves that originate in the spine.

Back pain affects almost everyone at some time. It is a common part of a modern lifestyle because we spend a large part of our lives sitting (eating, using a computer, reading, driving, watching TV etc) without exercising the major muscles in the back and buttocks. A hundred or more years ago when people walked everywhere and did a lot of physical work, back ache was rare.

The spine provides strength and protection to the sensitive spinal cord and nerve roots, while allowing flexibility and movement in all directions. A healthy spine is protected and encased in strong, flexible muscles that are regularly exercised by walking and stretching.

Back pain does not usually need urgent medical attention. Most episodes of back pain heal themselves with 4 to 6 weeks. Inflammation is often present, especially if there is an acute phase which typically lasts from two to twelve weeks.

Incidence of back pain

Back pain is the top cause of disability, measured by the aggregate number of years lived in poor health. It is the most common reason people need to take time off work. (3)

90% of people will experience back pain at some time in their lives, and half of all people will have an episode every year.

Lower back pain (lumbago) is a muscular-skeletal disorder that affects about 80% of people at some time in their lives.

In the USA 26% of adults report back pain lasting at least one day every three months. Also in the USA, 41% of adults aged between 26 and 44 years reported having back pain in the previous 6 months. (1)

Causes of back pain

The usual sequence of events

Abnormalities such as a slipped disc, misaligned spine or disc degeneration are common and found in many people. They do not necessarily cause pain or any other problems. It is possible to live a normal, pain-free life without even knowing that you have one of these "abnormalities". Disc degeneration is found in a third of people with no pain at all, and one in five people have no pain but do have a disc protrusion, a form of "slipped" disc. Bent or misaligned spines are even more common, including among healthy and athletic people. Usually a scan showing that you have such a problem does more harm than good.

Real, definitive physical causes of back pain such as a tumour, bone fracture, pressure on a nerve, infection or arthritis are only found in 5 - 15% of cases. All other cases are labelled as "non-specific".

Unfortunately MRIs and x-rays often find a slipped disc or misalignment in people who are suffering from back pain. The desperate patient usually demands swift intervention to fix the "cause" they believe the scan has revealed. Both patients and doctors think that if they can see something then they should do something. Patients who now believe that they have a damaged, fragile back start avoiding normal physical activity, especially walking.

Remember that most forms of medical treatment such as surgery and spinal injections are lucrative. Most back specialist doctors won't spend an hour explaining to a patient that the things seen on his MRI may not be the reason for his back pain, and that it is more likely to be his worrying financial, work or marital problems, disabled children or that he is not sleeping well.

Surgery with unproven benefits or which debilitates the patient or makes the pain worse, is common. In 2019 Cigna, an American health insurer, found that 87% of customers who had spinal-fusion surgery for wear and tear of spinal discs were in so much pain two years later that they needed further treatment. Spinal injections, another invasive treatment, often do little if any good.

The best treatment is usually non-medical, avoiding pharmaceutical drugs and hospitals. Better to do stretching exercises and keep moving. Don't lie around or in bed for days on end - that will likely make things worse. Above all, be patient. The problem is usually not your physical back, it is more likely that the brain's pain-signalling system is confused - and unfortunately medical experts do not know why. The pain may be partly or completely psychosomatic. In most cases the right exercises, relaxation and the passage of time will ease the pain. Unlike surgery and other invasive treatments, they cost little and are unlikely to make things worse.

Prevention / remedies / treatment for back pain

Tips for back pain

When lifting anything, bend your knees and keep your back straight. Use your legs to do the lifting, not your back. Avoid lifting and twisting at the same time.

Try sleeping on your back with a pillow under your knees, or on your side with your knees bent and a pillow between your knees.

See a doctor if you have:

References

1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976). 2006 Nov 1;31(23):2724-7.

2. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. May 1991, Spine 16 (5): 549-52. PMID 1828912.

3. The Economist Magazine dated 18 January 2020.