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Back pain

Overview of back pain

Back pain or low back pain refers to the pain and muscular stiffness experienced in the back region below the rib cage and above the buttocks.

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This may or may not be associated with pain in the legs or thighs. Almost all individuals tend to experience back pain at least once in their lifetime. Back pain is commonly noticed in individuals between the age 35 and 55 years. The worldwide prevalence of this condition is estimated to be about 13–44%, which results in most individuals taking leave for about a week from work.1,2

Back pain may be classified into two types: acute (short-term) or chronic (long-term). Individuals who suffer from back pain for <12 weeks at a stretch are denoted to suffer from acute back pain, while it is termed as chronic if the pain persists for >12 weeks.2,3

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Signs and Symptoms of back pain

The back pain may persist for either <6 weeks or >12 weeks in case of acute and chronic conditions respectively.

The pain may be associated with stiffness of the muscles of the back and the individual may not be able to perform any task that involves bending or stretching the back.

The pain may at times be felt in the buttock region or the legs along with the back. Other features, which are specific to the underlying condition may also be noted along with backache.1,4

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Causes of back pain

The exact cause for acute and chronic back pain cannot be identified in most of the cases (almost 85%) and is designated as nonspecific back pain.

Rarely, it may be attributed to fractures of the back or prolapse of the intervertebral disc that supports the spine.

About 1% of the acute back pain may be due to the presence of some tumour in that region.

In some instances back pain may be due to underlying conditions such as

Risk Factors for back pain

Below are recognised as some of the risk factors for nonspecific back pain.

  • Heavy physical work
  • Jobs that involve repeated bending, twisting or lifting
  • Being at one position (sitting or standing) for prolonged periods
  • Improper posture while standing or sitting 

Individuals who suffer from anxiety, depression or mental stress at work also tend to have an increased incidence of back pain.

Chronic back pain may usually be noticed in individuals with a history of repeated backaches.2–4

Diagnosis of back pain

The diagnosis of nonspecific back pain is based on the exclusion of the underlying causes of back pain.

The doctor may enquire about personal history, occupational history and the history of backache.

The doctor may ask the individual to perform some simple tasks such as lifting the leg, crossing the leg, walking on the toes, stretching the toes or feet and verify their reflex movements.

Specific diagnostic procedures such as radiographs, MRI or CT scan along with blood tests may at times be advised to rule out underlying pathologies.5,6   

Treatment of back pain

Most cases of nonspecific back pain tend to resolve with the administration of NSAIDs such as diclofenac sodium, ibuprofen, aceclofenac that are available as over-the-counter medications.

However, these drugs should not be consumed for prolonged periods, as they may result in kidney and gastrointestinal toxicity. A doctor should always be consulted to rule out any pathology before consuming any medication.

Other drugs that are commonly advised belong to the group of opioids and muscle relaxants.

Bed rest is not generally advised for acute nonspecific back pains as it may worsen the situation. If required the doctor may advice bed rest for not more than 2–3 days.

Any underlying pathology is treated appropriately.4,5

Use of NSAIDs for back pain

Alternative therapy for back pain

Following are some of the alterative therapies that have been found to be effective in varying proportions.

The doctors usually educate the individuals about proper care of the back and advise proper postures while performing work or while standing and sitting.

Counselling may be required for individuals suffering from anxiety or depression.1,4,5

Alternative treatment for back pain

Prevention of back pain

Exercise is considered to have a vital role in preventing the recurrence of back pain, as it helps in correcting the posture, strengthens the back and improves flexibility. However, these are to be performed after obtaining proper guidance from a physiotherapist.

Some of the steps that help in preventing the back pain while lifting or bending are given below.

  • Do not try to lift heavy objects alone
  • Get a proper support by spreading your legs to a comfortable position
  • Be as close to the object being lifted as possible
  • One should always bend at the knees and not at the waist while bending
  • Do not bend forward as one lifts the object and do not twist the waist while lifting or carrying the object

Measures to prevent back pain at work place include the following.

  • Avoid high heels
  • Make sure the chair one sits on has a straight back and, its height and arm rests can be adjusted to a comfortable position
  • When sitting for long time keep the knees at the level of the hips or slightly higher (use a small stool if needed), use a small pillow behind the lower back
  • Avoid sitting continuously for long periods; get up from the seat, walk a few steps and stretch the back a little
  • Practice relaxation techniques such as meditation and yoga7

Best exercise for back pain

Living with back pain

Although back pain may recur at times, proper care and preventive steps as provided above are generally helpful in relieving the symptoms and resuming work.

Living with back pain

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1. Koes BW. Diagnosis and treatment of low back pain. BMJ.  2006; 332: 1430–1434. 

2. Koes B, Van Tulder M. Acute low back pain. Am Fam Physician. 2006; 74(5): 803–805.

3. van Tulder M, Koes B. Chronic low back pain. Am Fam Physician. 2006; 74(9): 1577–1579.

4. Nguyen TH, Randolph DC. Nonspecific low back pain and return to work. Am Fam Physician. 2007; 76: 1497–1502, 1504.

5. Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician. 2007; 75: 1181–1188, 1190–1192.

6. Refshauge KM, Maher CG. Low back pain investigations and prognosis: A review. BJSM. 2006; 40: 494–498.

7. US Preventative Services Task Force. Primary Care Interventions to Prevent Low Back Pain: Brief Evidence Update. Rockville, MD: Agency for Healthcare Research and Quality; February 2004.

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