Types Of Back Pain

Neck Pain

Neck pain refers to any pain experienced in the area from the base of the skull to the shoulders and can spread to your upper back or arms.

This can include feelings of stiffness or tightness, as well as sharp pain and, in severe cases, can reduce the movement of the neck and head. Neck pain can also cause tension headaches.

Most muscles in the body will relax completely when they are not being used, but the muscles in the neck are permanently tensed in order to support the head. Although most common in people over 50, neck pain can develop at any age as the result of excess strain on the neck. This could include slouching, sleeping in an awkward position or working at a computer for long periods of time without a break.

Neck pain can also develop as the result of an accident. Perhaps the best known is whiplash; an injury sustained as a result of the head being thrown forward and back in a car accident.

Neck pain is rarely the result of a serious injury and will often lessen after a few days. If you are suffering from neck pain, try to keep moving and maintain your normal routine as best you can. Over-the-counter painkillers may also help.


Upper And Middle Back Pain

The upper and middle back refers to the section of vertebrae, known as the thoracic vertebrae, which runs from the base of the neck to the bottom of your ribcage. This type of back pain is less common than neck or lower back pain as the bones in this area are not required to move and flex as much.

Like many other types of back pain, upper and middle back pain can range from aching and stiffness to a sharp or burning sensation. Pain in this area is often the result of pinched nerves in the spine by the ribs.

One cause of back pain in this area is poor posture. Try to keep your back as straight as possible and balance your weight evenly on both feet. When sitting, keep your shoulders rolled back and be sure to adopt suitable positions when driving, sitting or using computers.

For more advice on ways you can protect your back, see the 'preventing back pain' section of this guide.

Lower Back Pain

This is the commonest type of back pain with around 8 out of 10 people affected at some time in their lives. The lower back is defined as the area between the bottom of the ribcage and the top of the legs. Symptoms range from tension and stiffness to pain and soreness.

Most people's back pain is described as non-specific, meaning it is caused by structures in the back as opposed to rare conditions such as cancer or a fracture.

The back is a delicate area of muscles, nerves, bones and joints and is continuously working hard to support the weight of the upper body. Lower back pain is often triggered by everyday activities such as bending awkwardly, lifting incorrectly, standing for long periods of time, slouching when sitting and driving for long periods without taking breaks.

The 'preventing back pain' section of this guide has advice on guarding against these common causes of back pain and includes tips on lifting correctly, sitting properly, using computers and avoiding back pain caused by driving.

Buttocks And Legs (Sciatica)

Sciatica is pain caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest nerve in your body and runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.

When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back and travels down your leg to your calf. This can be mild to very painful.

The most common cause of sciatica is a slipped disc. This occurs when one of the discs that sit between and cushion the vertebrae is ruptured. Most cases of sciatica will pass without the need for treatment. A combination of the self-help measures described in this guide such as over-the-counter painkillers, exercise and hot or cold packs can usually relieve the symptoms.

For persistent sciatica, you may be advised to try a structured exercise programme under the supervision of a physiotherapist. In rare cases, surgery may be needed to control the symptoms.

Urgent (Red Flag Symptoms)

Most cases of back pain will usually get better without medical help. However, there are a number of warning signs, known as 'red flags', which may indicate that your back pain is serious.

These red flag signs include:

·         A high temperature (fever) of 38C (100F) or above
·         Unexplained weight loss
·         Constant back pain that does not ease after lying down or resting
·         Pain that travels to your chest or that is high up in your back
·         Pain down your legs and below the knees
·         A recent trauma or injury to your back
·         Loss of bladder control
·         Inability to pass urine
·         Loss of bowel control
·         Numbness around your genitals, buttocks or back passage

If you have any of the signs or symptoms listed above, contact your GP immediately. If this is not possible, you can telephone NHS Direct on 0845 4647.

You should also seek medical advice if you are having back pain and:

·         You are under 20 or over 55 years old
·         You have taken steroids for a few months
·         You misuse drugs
·         You have or have had cancer
·         You have a weakened immune system as a result of chemotherapy treatment or a medical condition such as HIV or AIDS

Also contact your GP if your symptoms fail to improve within three days or you have persistent pain that lasts longer than six weeks.

Evidence For Acupuncture

Evidence For Its Effectiveness 

There is some scientific evidence that acupuncture is effective for a small number of health conditions. However, for the majority of conditions for which acupuncture is used, the scientific evidence is inconclusive or there has been no attempt to collect good-quality evidence. For a small number of conditions, there is evidence that acupuncture does not work.
More research is needed into the effectiveness of acupuncture on a wide range of conditions.
It is important to remember that when we use a treatment and feel better, this can be because of a phenomenon called the placebo effect and not because of the treatment itself.
When scientists gather evidence on the effectiveness of a treatment, they take the placebo effect into account. For more information, watch a video about the placebo effect.

Positive Evidence

• There is reasonably good evidence that acupuncture is an effective treatment for:
• Chronic back pain
• Dental pain
• Pain and discomfort during gastrointestinal endoscopy
• Headache
• Nausea and vomiting after an operation
• Pain and discomfort during oocyte retrieval (a procedure used during IVF)
• Osteoarthritis of the knee

Scientific trials conducted to investigate the effect of acupuncture on these conditions found that acupuncture had a beneficial effect.
However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions.
Some scientists believe that good evidence exists only for nausea and vomiting after an operation. Others think that there is currently not enough evidence to show that acupuncture works for any condition.
More research is needed to investigate whether acupuncture works for these conditions.

Negative Evidence

There is some evidence that acupuncture does not work for:

• Rheumatoid arthritis
• Stopping smoking
• Losing weight

This means that when scientific trials were conducted to see if acupuncture helped patients in these cases, they found that the treatment had no effect.
As with the positive evidence on acupuncture, this evidence does not allow us to draw definite conclusions. More research is needed into the effectiveness of acupuncture for these conditions.
Inconclusive or no evidence

For most conditions against which acupuncture is used, we do not have enough good-quality evidence on the effectiveness of acupuncture.
More research is needed before we can draw conclusions on whether acupuncture is effective for the following conditions:

• Addictions
• Asthma
• Chronic pain
• Depression
• Insomnia
• Neck pain
• Sciatica
• Shoulder pain
• Stroke
• Tinnitus

Acupuncture: Is It For You?

Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.
It is a complementary or alternative medicine (CAM). This means that acupuncture is different in important ways from treatments that are part of conventional western medicine. Unlike conventional treatments, the use of acupuncture is not always based on scientific evidence.

Theory

Acupuncture is based on the belief that an energy, or 'life force', flows through the body in channels called meridians. This life force is known as Qi (pronounced 'chee'). Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.

Uses

Practitioners – called acupuncturists – use acupuncture to treat a wide range of health conditions. It is often used to treat pain conditions such as headache, lower back pain and dental pain, but is also commonly used against conditions ranging from infertility to anxiety and asthma. To learn more, see Common uses of acupuncture.
The availability of acupuncture on the NHS is limited. Most acupuncture patients pay for private treatment.

Does it work?

There is some evidence that acupuncture works for a small number of conditions, including migraine and post-operative nausea. However, there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used. More scientific research is needed to establish whether acupuncture is effective against these and other conditions.
There is no scientific evidence for the existence of Qi or meridians. Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for the beneficial effects that have been observed in some scientific trials. More research is needed before acupuncture’s method of action is fully understood.
For more information, see Evidence for acupuncture. If you choose to have acupuncture, make sure that your acupuncturist is fully qualified and practises the treatment under safe and hygienic conditions.
Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option only for lower back pain.