BACK CHAT

EACH YEAR, AUS­TRALIANS SPEND $1 BIL­LION ON TREAT­MENTS FOR BACK PAIN. SO WHAT CAUSES IT AND HOW TO TREAT IT? BY Stephen Lacey

Sunday Herald Sun - Body and Soul - - HEALTH -

“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:

1Sim­ple

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.

2Chronic

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.

3

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.

TREAT­MENTS

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.

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