Back pain is a common ailment in our community – up to 85% of adults will suffer a significant episode of back pain at some time in their life.
Fortunately, most episodes will respond to conservative management.
Appropriate strategies include activity modification, a brief period of bed rest, pain relief, anti-inflammatory medication and physiotherapy.
Chiropractic treatment has been shown to be helpful in acute back pain, but not chronic back pain.
A minority of back pains will be slow to settle, or may be associated with significant underlying disease such as infection, tumour, disc herniation, fracture, intra abdominal pathology or rheumatological disorder. In cases where the pain is severe or not improving, or is associated with systemic disorder, such as fever, weight loss, nausea and vomiting, medical assessment and advice should be sought.
Chronic back pain, or chronically recurrent back pain, may be associated with underlying degenerative changes. It may be improved by attention to weight and fitness, core muscular strength, modification of work practices and postures, improvement in spinal posture, and the judicious use of medication.
A small subgroup of patients with chronic back pain may have structural problems that require more substantial intervention. These patients should ultimately be assessed by a spinal surgeon.
Interpretation of imaging in patients with back pain requires experience and caution. Up to 20% of MRI scans will demonstrate abnormalities such as disc bulges, ’dark discs’, minor malalignments, Tarlov cysts, dilated central spinal canal and facet joint arthritis, which may or may not be clinically important.