Back pain 

Back pain is the largest cause of absence from work in the UK. Philip Sell, consultant orthopaedic and spinal surgeon, discusses the causes of and treatments for back pain.

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Transcript of Back pain

Why do people get back pain? Well, that's a question I'm often asked.

And, to be honest, I often don't know.

What I do know is that we're very good, as doctors,

at excluding the serious things that can cause back pain,

such as cancer, infection or pressure on the nerves.

When we look at the scientific evidence,

the most common cause of back pain is probably genetically determined.

It's not caused by work, it's not caused by lifting or carrying.

But often patients will have the feeling that's precipitated the episode.

Most muscular-skeletal disorders get better on their own.

They're self-limiting. They'll wax and wane.

So if your back pain's getting better, you don't need to see your doctor.

If it's been going on or getting worse,

and if it's been going on for more than about ten days,

you should think about seeing your doctor.

If a friend was going to see their GP because of back pain,

I'd make sure that they asked about getting given a copy of The Back Book,

which we know is very helpful.

I'd ask them to make sure that the GP examined them properly

and gave them good pain relief.

Your doctor may well ask you about red flags.

Red flags are the signs that we use and the symptoms we use

to determine whether it could be something serious.

So if you've ever had a history of cancer surgery,

if you're losing weight, if you're feeling very unwell with it,

if you've got any disturbance of bowel or bladder function

or significant neurological symptoms in the arms or legs,

that's when you should see your doctor.

Most back pain is probably caused

by muscular issues or ligamentous issues.

We'd rather move away from asking, "Why have I got back pain?",

to saying, "What can I do to make it better?"

That's really quite simple to deal with.

Usually the best thing to do is to take regular painkillers,

so you've got an umbrella of pain relief.

You don't mask the pain.

You won't hurt yourself without knowing it,

but by getting rid of the pain, it helps you get better quicker.

So it's really important to take regular painkillers.

Simple over-the-counter things

like anti-inflammatories and some paracetamol.

The other thing is not to rest up too much.

It's almost that the sooner you get moving,

the sooner your back pain will start to get better.

We advise against bed rest. That's positively harmful for backs.

Once you're moving better,

consider what you can do to stop it happening again.

There's lots of things that will work. Physiotherapy can be very helpful.

Intensive spinal rehabilitation can be very helpful.

Surgery's got a very limited role for simple back pain,

and, actually, we tend to try and get people better without surgery.

We might operate for sciatica, which is unresolved leg pain.

We would certainly consider surgery for urgent conditions,

such as cancer or infection.

And we'll sometimes operate for spinal deformity.

If it does come to surgery, that will be very carefully discussed.

Less than three per cent of patients

with serious, severe, long-standing back pain

might be suitable candidates for surgery.

We would tend to do a MRI scan

to see whether it's one-level problems at the disc

or two-level problems or three-level problems.

We will then do pain provocation tests

and then consider what operations might help.

The two operations, basically, would be either a spinal fusion,

where we chop the disc out and then fuse it with bone,

or an artificial disc replacement.

That's where we put an artificial disc to replace the one that we've removed.

Both these operations can be very helpful for pain,

but they can have quite serious complications

if things don't go well.

Those serious complications, although they're infrequent,

might include infection, damage to the nerves,

damage to the main blood vessels or even death.

What would I advise a friend to ask a surgeon

if they were seeing them about surgery?

I'd suggest that they ask the surgeon

how many of these operations they do each year.

I'd ask them for the information and consent forms

that they usually give to their patients regarding this type of surgery.

And I'd ask them if they have any outcome measures or results

that they can show me regarding the outcomes of surgery.

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