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When should I seek help for acute back pain?

By Natalie Whish-Wilson

The answer to this question can be both simple and complicated depending on many factors. Back pain is very personal to you as an individual -since any pain you have ever experienced originates from your brain. Pain is a response by your brain to any sort of stimulus that it perceives as “dangerous” to your well being. A stimulus could be a torn muscle, tendon or ligament, overloaded muscle, tight muscles, compressed or broken bones, disc or nerve irritation etc.

In an acute or sudden onset of a new episode of back pain (as opposed to chronic back pain that has persisted longer than 3 months) it is important to understand that the purpose of pain is to make you change your behaviour (rest, relax, seek medical attention, unload etc) so that healing can occur.

Back pain affects millions of people every year but not all episodes of back pain will require any treatment at all. It is actually quite common for your pain to settle within the first couple of weeks on its own.

That being said, it’s important that you take care to rest a little before carrying on with your normal activities, particularly if you play competitive sport, lift heavy items, sit a lot or perform heavy manual labour for example.

This doesn’t mean you should lay in bed for a week. It is now well understood that gentle movement is important in the early stages of injury or pain. Conversely pushing through your pain to the extent that you make your symptoms worse is also not recommended. Finding a happy medium is always a challenge and stress will often make symptoms a whole lot worse- so it's important not to catastrophise or think the worst, as your pain will generally resolve with a little time.

Many factors will dictate how much you should modify your activities and it is sometimes worth checking in with your Physio as to what activities are ok and those best to avoid, which may ultimately depend on the type of injury or pain that you are experiencing. For example bending and sitting may be worse for some types of back symptoms and stretching or walking may be preferred for others. There are often some simple exercises that will help you to keep moving whilst you are recovering from an episode of acute back pain.

You might also need some medication for your pain. Many people try and avoid pain medication but this can be detrimental in some instances. Untreated pain can have a profound impact on your quality of life and inappropriately managed acute pain can result in immunological and neural changes, which can progress to chronic pain if untreated. Moreover it can lead to poor sleep which is generally the best time for your body to heal itself.

The first recommendation for pain relief is usually paracetamol/panadol. If this is not giving you enough relief even with modifying your activity, your GP may recommend anti-inflammatories /NSAIDs before trying other types of medication (which might be aimed at relaxing muscles or for targeting nerve pain).

It is usually unnecessary to have any xrays or scans in the first 3 weeks unless there has been some trauma/accident, or if you have any underlying conditions that could potentially predispose your bones to fracture such as osteoporosis. Many people may have visible degenerative changes on xrays that are often age related and often pre existed before their injury. Having xrays can actually lead to additional procedures that complicate recovery. A large study of people with back pain found that those who had imaging tests soon after reporting the problem fared no better and sometimes did worse than people who took simple steps like applying heat, staying active, and taking an simple pain medications. Another study found that back pain sufferers who had an MRI in the first month were eight times more likely to have surgery, but didn’t recover faster.

In most cases, acute back pain is not a cause for worry however, it can be uncomfortable, irritating and inconvenient. If however, you are experiencing any of the following symptoms then you should definitely seek medical attention as soon as possible from your GP.

  • Persistent fevers.
  • Unexplained weight loss.
  • Blood in the stool or urine.
  • Progressive numbness or weakness in the arms or legs, especially inability to pull the foot upwards
  • Inability to urinate or have a bowel movement.
  • Loss of bowel/bladder control.
  • Unrelenting Pain at night which often doesn’t change with movement or static postures.
  • Sexual dysfunction.
  • If you have a history of cancer it might also be worth checking in with your GP if your pain is severe and new.

Avoiding back pain in the first instance can be as simple as changing the way you approach posture, movement and loads in your body. Sometimes some simple advice and pain education can go a long way.

Likewise, maintaining or achieving adequate strength, flexibility, coordination, balance, endurance and skill for the activities which you want to participate in, is vitally important.

Most sane people wouldn’t compete in a marathon without training for it and the same idea can be applied to training for activities of daily life such as housework, lifting and gardening which can put extra loads on your joints and muscles.

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