C o n ta c t
D e ta i l s
Spinal Triage
Nuffield Orthopaedic Centre
Windmill Road
Headington
Oxford
OX3 7LD
Phone:
Fax:
01865 738051
01865 738027
Web Site
www.noc.nhs.uk
Non-Specific
Spinal Pain
Your back pain diagnosis
NSLBP Patient Information version 1
© 2005 Nuffield Orthopaedic Centre
Elaine Buchanan June 2005
Review June 2006
Information to supplement the Back Book
A lot of research into back pain has been done and lots more
research is currently underway. We recommend that you read
the back book to make sure you are up to date with the latest
thinking.
Useful things that I could start to do now
Fitness:
Key messages from the Back Book
• Back pain is common but is rarely due to any serious
Work:
disease. The long-term outlook is good.
• Even when it is very painful, that doesn’t usually
mean that there is anything serious or damage to
your back. Hurt does not mean harm
Why healthcare professionals (HCP) are using
a new label
For many years HCP (doctors, physiotherapist, osteopaths,
chiropractors) have had theories about what causes normal
back pain. Nowadays there are very sophisticated ways of
looking inside backs, such as scanning. It is by doing this that
researchers have found that many of our theories are wrong.
In fact in 85 out of 100 people with back pain no specific
problem with the anatomy of the back can be found.
Old fashioned Diagnosis for Non-specific low Back Pain
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Arthritis
Dislocated Pelvis
Lumbago
Sacroiliac malalignment
Slipped disc
Spondylosis
Trapped Nerve
Hobbies:
Pain control:
Useful reading
For back pain
• The Back Book ISBN 0-11-702949-1
For pain that is limiting your activity
• Manage Your Pain ISBN 0-28-563679-0
If you take these details to any large bookshop they will be
able to get the book for you.
On-line
www.backcare.org.uk
www.workingbacksscotland.com
www.backpaineurope.org
What can other people do for me?
It is what you tell the HCP, rather than any test which help most
with the diagnosis. X-Rays and scans do not help with
diagnosis in non-specific low back pain.
HCP can cure some conditions, such as a chest
infection. In many other conditions however treatment is
not aimed at curing but at managing the problem. Back
pain is an example of this.
The consultation with a HCP will provide sufficient information
to exclude a specific or serious cause for back pain. By
receiving this diagnosis you can be confident that your back
pain is not any of the conditions listed in the box below.
Diagnosis
Treatment
Result
Chest infection
antibiotics
cure
Asthma
inhalers
manage symptoms
Non-specific
Back Pain
pain killers
activity
manage symptoms
We cannot cure non-specific back pain and treatments
available generally will give short term symptomatic
relief. HCP can give you advice to help you continue or
return to normal activities including work. With time
back pain does seem to improve through natural
recovery.
Health care professionals can help you help yourself.
Treatments for managing flare ups of back pain are
outlined in the Back Book. Pages 7—10.
What your back pain is not
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Cancer
Collapsing/crumbling bones
Surgical disc prolapse
Broken bones
Osteoporosis
Inflammatory disease
Scoliosis
Spinal infections
There is no question that back pain is real and comes from a
physical problem in the back It is now thought that back pain is
a disturbance of how the back functions rather than structural
damage or disease. These often improve by themselves with
time.
At an early age our body begins to mature, for example by the
age of 20 it is normal to have a few wrinkles, and perhaps a few
grey hairs or altered eye sight. Changes in the structure of the
tissues in the spine are also common. These changes tend to
happen in several parts of the back (disc, muscle, ligaments)
and at several levels. These changes happen in everyone, not
just people with back pain. It is for this reason that HCP cannot
be specific as to which tissue the pain is arising from.
Back pain is not a psychological problem. How we think and
feel however has been shown to influence how we react to pain
and how it affects us.
What is likely to happen in the future?
From the age of 15 onwards, 1 in 4 adults report back pain.
Typically the pain goes through good and bad spells. When we
are younger (<20) and older (>55) the severity of the pain is
generally less. It is the 20—55 years old who report the most
bothersome pain. In some ways that’s good because back pain
generally improves as we get older.
Key messages from the back book
Bed rest for more than a day or two is usually bad for
you.
Staying active will help you get better faster and
prevent more back trouble.
The sooner you get going the faster you will get better.
If you don’t manage to get back to most normal activities quite quickly, you should seek additional help.
Regular exercise and staying fit helps your general
health and your back.
You have to get on with your life. Don’t let your back
take over.
Follow these steps to get back in action:
You know that activity is good for your health – it is just the same
for your back. Keeping your back moving stops the working
parts of your back from seizing up. It may hurt a bit at first, but it
does not do any damage – hurt is not the same as harm. It’s
worth working through any initial discomfort – because you’ll get
back to normal that much quicker.
What can I do to help myself?
Recovery and relief of pain depend on getting your back moving
and working again despite the pain. The answer is to get moving
and get fit again. It also depends very much on you taking responsibility for what you do, rather than depending on a HCP to
fix it. Being physically fit including stopping smoking and
carrying excess weight, will help you manage it better.
What type of exercise is best?
The ones that you enjoy and will keep doing.
What about work?
People of working age commonly get back pain and it
impacts on their work However research suggests that work
is not physically harmful to the back. Any back pain, whatever
the cause, may make it more difficult to meet certain physical
demands of work. Work is generally good for people with
back pain as it help keep the back moving and strong. In fact
getting back to work can help you recover faster. You don’t
have to wait till the pain is 100% gone.
Key message from the back book
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You don’t have to do special exercises. Simply continue to do
your ordinary activities as normally as possible. Of course you
may need to take it a little easier at first. Being active little and
often is a good idea. Being fit and active will help you get better
faster and reduce the risk of more back trouble later.
Try to remain at work or get back as soon as possible even if you still have pain. The longer you stay
off work the more likely you are to develop chronic
pain and disability. It is best to discuss work
problems with your employer.