FEATURE
> with age. This can put the spin under undue stresses and can cause serve pain. Other mechanical causes include spasms, muscle tension, or ruptured disks.
• Injuries – Sprains or fractures can cause acute or chronic pain. Sprains are defined as tears in the ligaments that support the spine, usually caused by twisting or lifting improperly. Fractured vertebrae are most common in patient with osteoporosis. More severe injuries can occur as a result of a fall or an accident, however in comparison these are less common.
• Acquired conditions or diseases – Many diseases can have effects on the spine or back and as such back pain is often a symptom. Scoliosis (curvature of the spine), spondylolisthesis, arthritis (including osteo-, rheumatoid arthritis, and ankylosing spondylosis), and spinal stenosis (narrowing of the spinal column that puts pressure on the spinal nerves) can each result in mild, moderate and serve back pain.
• Infections and tumours – These conditions are much rarer than the other conditions listed above and will usually be treated in a specialist hospital ward. Infections usually require strong antibiotic treatments and tumours may require surgery (which can carry significant risk to the integrity of the spinal column). [3]
Although the causes of back pain are usually physical, and can normally be attributed to an incident or disease state, emotional stresses can play a role in how the pain is perceived. Pain perception ranges dramatically from person to person.
In terms of back pain prevention, what can be done? There are some steps that can be taken in order to reduce the risk of developing back pain, and these revolve mainly around
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maintaining the integrity of the muscles in the back.
Building muscle and improving muscle tone can aid in ensuring that when the back muscles are put to use, they are adequate to cope with the movement required. For many people lifting heavy objects is required as part of their work and so it is suggested that anyone carrying out heavy lifting adhere to appropriate working practices. Guidelines are available for how to safely lift and move heavy items, and adhering to these can help to reduce the risk of developing back pain. [4]
In many cases it is not necessary to schedule an appointment with the GP, as many back pain problems caused by muscular issues are short lived and can be resolved through rest, or appropriate exercise. If back pain is associated with other symptoms for example tingling or numbness, then it may be necessary to seek medical help.
If the pain is severe or does not
improve with rest, or associated with: trouble urinating, weakness, numbness in the legs, fever, or unintentional weight loss – similarly a visit to the GP would be suggested as this could indicate a more sinister issue.
There are many treatment options available for back pain, and the most appropriate treatment will depend on how the back pain began or if it is acute or chronic in nature. Acute back pain is usually self limiting and does not always require further treatment, however in some instances an analgesic, such as Paracetamol or a non steroidal anti-inflammatory drug like ibuprofen, can help to reduce the pain. Continuing as much as possible with day to day activities and moving around can help to ease stiffness,
relieve pain, and allow you to return to full activities sooner.
Chronic back pain can be more challenging to deal with – this is primarily due to the nature of chronic pain.
As the pain continues over a period of time, an emotional component can start to have a significant impact on the pain. This can be particularly challenging to treat with traditional drug therapies, however some cognitive behavioural therapies have shown to be effective in helping with neurobehavioral disorders. In a small number of cases, where pain is caused by a tumour or infection, surgery may be required to remove the tumour or tissues, so that further problems can be avoided.
A number of non-surgical treatments are available and these include:
• Hot and cold treatments – Hot and cold (and often a combination) packs can be soothing and relieve pain and tension. The heat helps to dilate blood vessels, improving blood flow and increasing oxygen transit, this in turn can help to relive muscle spasm. Cold packs can help to reduce inflammation, constricting blood vessels. The application of hot and cold packs can significantly alter the sensation of pain, but will not cure the problem.
• Exercise – Exercise is not often advisable for acute pain; however appropriate exercises can help reduce the risk of pain returning.
• Medication – A number of medications are available on prescription and over the counter for the treatment of back pain, and understandably this is often an area where a pharmacist is likely to be most knowledgeable. Briefly, the most
commonly used medicine groups are listed below: - Analgesics: These medicines are short acting and are specifically designed to reduce pain e.g. paracetamol and aspirin - NSAIDs: Non steroidal anti- inflammatory drugs, such as ibuprofen, ketoprofen, or naproxen. These medicines are sometimes available as tablets, and other times are formulated as gels/creams for external application - Other medicines: Some muscle relaxants and certain anti-depressant drugs can also be used as additional therapies to help reduce the impact of chronic pain on day to day living
As pharmacists, it can be tempting to jump straight to medicines are the first line treatment of common conditions, when this may not be the most appropriate first step. In many cases analgesic medicines which help manage pain are a good option, however it is important that appropriate exercise regimen or rehabilitation process is initiated.
This supports the need for a truly interdisciplinary approach involving Physiotherapy, General Practice Medicine, Nursing, and Pharmacy. With a broad understanding of patient needs and a detailed expertise in medicines, Pharmacist are well suited to fulfil the lead role in progressive managements of common patient complains such as musculoskeletal issues like back pain. n
References: 1 The Back Pain survey. Accessed 18-01-16. Available at:
http://www.paincommunitycentre. org/biblio/back-pain-survey 2. Musculoskeletal MSD statistics. Accessed 18- 01-16. Available at:
http://www.hse.gov.uk/ statistics/causdis/musculoskeletal/msd.pdf 3. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Accessed 18- 01-16. Available at:
http://www.niams.nih.gov /Health_Info/Back_Pain/#2 4. Lifting Operations and Lifting Equipment Regulations 1998. Accessed 19-01-16. Available at:
http://www.hse.gov.uk/work-equipment- machinery/
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