EACH YEAR, AUSTRALIANS SPEND $1 BILLION ON TREATMENTS FOR BACK PAIN. SO WHAT CAUSES IT AND HOW TO TREAT IT? BY Stephen Lacey
“T here are examples in ancient medical texts of physicians treating back pain,” says Professor Christopher Maher, director of musculoskeletal research at The George Institute for International Health. “The problem dates back thousands of years, but I would say it’s more prevalent now.”
Studies show that about 25 per cent of Australians suffer from back pain at any point in time and 50 per cent suffered in the past month. Studies also suggest that women are more susceptible to chronic back pain than men.
Back pain affects people of all ages, although onset is most common in middle age. Recent data shows that teenagers also suffer from back pain: a US study found that 43 per cent of 15-yearold girls and 33 per cent of 15-year-old boys report a back ache once a week.
Each year, Australians spend $1 billion on back pain treatments. Indirect costs, such as loss of wages and productivity, run to $8 billion.
There are currently few resources allocated to back pain research. “It’s a neglected area,” says Professor Maher. There are no specific tests available that can identify the damaged or inflamed tissue. “People think a CT scan will tell them what’s wrong with their back, but most of the time it doesn’t,” he says.
While there are laboratory tests – where needles are inserted into the suspected tissue, which is then anaesthetised – this is too invasive to use routinely.
“We need simpler tests so we can provide a more targeted treatment,” Professor Maher says.
First, a quick spinal lesson 101. Vertebrae are the bony blocks that protect the spinal cord and provide the basis for movement. Each of us has five vertebrae in the lumbar (lower) spine, 12 in the thoracic (mid) and seven in the cervical (neck). Your tail bone (sacrum and coccyx) is made up of a number of bones that fuse together at adulthood. Between each vertebra are discs that keep the bones apart and allow them to move back and forth. The whole spine is supported by muscles and ligaments.
Professor Maher says back pain is divided into four main categories:
mechanical back pain:
Some 95 per cent of people fall into this category. “We’re not sure what causes the pain,” Professor Maher says. “It could be damage to the facet joints of the vertebrae, the annulus [outer covering] of the disc or sacroiliac joint [where the pelvis joins the lumbar spine], sprained ligaments or muscle strain.” Analgesics and hot and cold packs are used initially. If that doesn’t work, physiotherapy or chiropractics is recommended.
back pain: This is simple mechanical back pain that has persisted for at least three months. Professor Maher recommends exercise programs, whole-body stretching and cognitive behaviour therapy.
Sciatica: Representing about four per cent of back pain cases, this is where a damaged spinal nerve (usually caused by a disc protruding on to it – a herniation or slipped disc) leads to back pain and numbness, and pain and pins and needles down the leg. Patients are managed with the same methods as those used for mechanical back pain. Surgery is an option, but Professor Maher says it’s usually avoided, as the long-term results are similar to other treatments.
4 Serious pathology: More serious cases such as fractures and infections account for less than one per cent of cases.
Unfortunately, after an episode of back pain resolves, one in four people will experience a recurrence within one year.
Analgesics: Drugs won’t cure the problem, but they may ease symptoms.
“Most people reach for a simple pill such as Panadol initially,” says body+soul columnist Dr Cindy Pan. “If the pain is more severe they might want something stronger, containing codeine.”
Hot and cold packs: Some people find the application of heat and cold offers symptomatic relief. “Just be careful not to burn yourself,” warns Dr Pan.
Try cold treatment first. Wrap some ice in a tea towel and apply to the area for 20 minutes, every three or four hours.