Back Pain Symptoms Treatment and What to Expect When You See Your GP Or Polyclinic Doctor

1.      Localised back pain

2.      Acute back pain

3.      Chronic back pain (pain lasting more than 12 weeks)

4.      Back pain associated with walking (pain and numbness)

5.      Back pain associated with leg pain (Sciatica)

TCM

Acupuncture is one of the best-known practices within traditional Chinese medicine (TCM), with a history stretching back over 2,000 years and is commonly used to treat neck, back and shoulder pain.

Exercise

Regular exercise, including low-impact exercises like Pilates and Yoga, can help reduce back pain by strengthening the muscles that support the spine. Staying active can also reduce back stiffness and improve overall mobility, making everyday activities easier.

GP / Polyclinic Assessment

Most patients with back pain do not need to see a specialist and can be treated by their GP or polyclinic doctor. The initial treatment typically includes rest, medication and sometimes physiotherapy. Your doctor will access your symptoms and check for “red flags”, if present, you may be referred to a specialist outpatient clinic or an emergency department for further treatment. 

In most cases, specialist referrals are only considered if symptoms do not improve after about 6 weeks, or if there are worsening symptoms or neurological problems. 

What you can do:

-          Do normal activities as tolerated

-          Identify and avoid pain triggers

-          Correct posture

-          Use proper bending and lifting techniques

-          Weight loss

-          Smoking cessation

Commonly Prescribed Medication

-          Simple analgesia

           -   Paracetamol

-          Muscle relaxant

           -   Orphenadrine

-          Anti-inflammatory

           -   Arcoxia

           -   Nurofen

-          Opiods

           -   Tramadol

-          Neuropathic pain agents

           -   Gabapentin

           -   Pregabalin (Lyrica)

Medication for back pain should be taken as instructed by your doctor and should be taken for as short as possible.

Symptoms:

-          Maybe related to strenuous activity or carrying heavy loads

-          Leg pain (sciatica) often one sided

-          No improvement despite medication and physiotherapy

Treatment options:

Nerve root or epidural injection

A local anaesthetic and steroid is injected into the epidural space or directly into the nerve root. This reduces the inflammation or swelling of nerves in the epidural space, reducing pain, tingling, numbness or other symptoms.

This course of treatment is relatively low-risk; with bleeding, infection, nerve damage or weakness occurring about 1% of the time. Nerve root or epidural injections are not guaranteed to work and their effects may be temporary.

Lumbar Discectomy

Lumbar discectomy is a surgical procedure to remove a portion of the prolapsed lumbar disc. The surgery is usually performed with a minimally invasive technique, leaving a small scar.

Lumbar discectomy is a patient’s best chance at a cure, although recurrence is possible. The surgery has a 3-5% rate of complication, and less than 1% chance of paralysis.

Lumbar stenosis is caused by narrowing of the spaces within the spine putting pressure on the nerves travelling through it.

Symptoms

Back and leg pain

-          With walking

-          Relieved by rest

-          Can also be described as heaviness, weakness, tiredness in legs when walking

-          Numbness

-          Often both legs

-          Infrequently: paralysis, incontinence

Treatment

-          Medication, physiotherapy

-          Epidural injection

-          Surgery

•      Depending on severity of symptoms

•      Usually involves decompression of posterior elements

•      Can be done minimally invasively

•      Instability requires fusion (rods and screws)

•      High recovery rates

Back pain is very a common condition, and in most cases, improves with time, medication, exercise and physiotherapy. While most back pain does not require specialist treatment, watch out for red flags.

Ref: F26