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Back pain

from Medical topics

Published online by Cambridge University Press:  18 December 2014

By
Amanda C. De C. Williams
Edited by
Susan Ayers ,
Andrew Baum ,
Chris McManus ,
Stanton Newman ,
Kenneth Wallston ,
John Weinman  and
Robert West
Amanda C. De C. Williams
Affiliation:
University College London
Susan Ayers
Affiliation:
University of Sussex
Andrew Baum
Affiliation:
University of Pittsburgh
Chris McManus
Affiliation:
St Mary's Hospital Medical School
Stanton Newman
Affiliation:
University College and Middlesex School of Medicine
Kenneth Wallston
Affiliation:
Vanderbilt University School of Nursing
John Weinman
Affiliation:
United Medical and Dental Schools of Guy's and St Thomas's
Robert West
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Back pain is so common its impact is often under-estimated. Chronic back pain is a seriously disabling condition, which causes much distress (Smith et al., 2001; Sprangers et al., 2000). A survey of Scottish adults (Smith et al., 2001) showed that 14% reported continuous or intermittent pain for at least 3 months, for which they had taken analgesics and sought treatment. Nearly half of these people reported severe functional limitations in direct proportion to the severity of their pain. Chronic pain, of which back pain usually constitutes the largest category, was also associated with poorer physical and mental health.

Much back pain is dealt with in the United Kingdom in primary care and often involves physiotherapeutic intervention. If the back pain does not resolve or the individual does not adapt, referrals are often made to orthopaedics, rheumatology, or in some cases to neurosurgery. Optimal treatment consists of explanation and reassurance, with minimal rest, and encouragement to return to activities despite continuing pain. This contrasts with traditional advice, which tends towards prolonged rest and a cautious approach to physical activity. Any delay in referral for investigation and expert diagnosis tends to leave the patient in limbo with neither reassurance nor advice, thereby contributing to disability.

There are many possible causes and mechanisms of low back pain (Waddell, 2004). Some symptoms or physical signs indicate urgent and often operable conditions, such as tumours. These symptoms and physical signs are labelled ‘red flag’ indicators and suggest referral onto specialist services is appropriate.

Type
Chapter
Information
Cambridge Handbook of Psychology, Health and Medicine , pp. 563 - 565
Publisher: Cambridge University Press
Print publication year: 2007

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