Back Pain:First Aid

                                                                                                                   
The following self-help treatments may help to relieve back pain.

Apply Heat And Ice

Apply an ice pack to the affected area. If you haven't got an ice pack, use a bag of frozen vegetables instead. Don't put the ice directly on your skin, as it might cause a cold burn. Put a wet cloth between the ice and your skin.

If ice doesn't work, try applying gentle warmth with a hot water bottle. Don't apply the hot water bottle directly to the skin - cover it so it isn't too hot. A hot bath or shower might also help.

Some people find alternating heat and cold produces most relief. Try to get professional advice on applying heat and ice if you can.

Medication

Take painkillers following the instructions on the packet - never take more than the recommended dose. Many people find that paracetamol or ibuprofen helps - your pharmacist can advise you.

Painkillers shouldn't be used as a long-term solution. If you find you still need them after a week or so, consult your doctor.

Relaxation

Muscle tension is bad for back pain, so try to relax as much as possible. Take a long bath or listen to soothing music. Use a relaxation tape if you have one.

A gentle massage from a partner or friend may help, but make sure they don't do anything that causes pain.

Topical anti-inflammatory gels such as ibuprofen can also be massaged gently onto the skin over the back.

Bed Rest Versus Exercise

Doctors used to recommend long periods of rest for people with backache, but research has shown this is actually bad for backs. Even crawling around on your hands and knees is better than no movement at all.

Some kinds of exercise, such as walking, don't put too much stress on your back. It's a good idea to make a start on them even if your back is a bit sore, just to get your joints moving and your heart and lungs working.

Use a firm chair when sitting down, or sit on the floor rather than a sofa that’s too soft. Similarly, make sure your bed is firm enough.

Getting Back To Normal

In most cases, the back recovers naturally if allowed to do so and the pain should settle in a couple of days. Once this has happened, continue getting back to normal activities and try not to stay in one position or do any one activity for more than 30 minutes.

Avoid lifting, bending or twisting until the pain has gone for a few days. Refrain from returning to the activity that caused the pain for a week or so, even if you feel better, and gradually build up your exercise and activities day by day.

Don't just listen to your friends and relatives - ask an expert. Talk to your doctor or a properly physiotherapist, osteopath or chiropractor.

Treating ankylosing spondylitis Part 1

There is no cure for ankylosing spondylitis (AS). Treatment aims to relieve symptoms and slow the process of the spine stiffening.

Physiotherapy

Keeping active can improve your posture and your range of spinal movement, as well as preventing your spine from becoming stiff and painful.

As well as keeping active, physiotherapy is a key part of treating ankylosing spondylitis. A physiotherapist (a healthcare professional  trained in using physical methods of treatment) can advise about the most effective exercises and draw up an exercise programme suitable for you.

Types of physiotherapy recommended for ankylosing spondylitis include:

• Group exercise programme, where you exercise with others
• An individual exercise programme – you are given exercises to do by yourself
• Massage – your muscles and other soft tissues are manipulated to relieve pain and improve movement (the bones of the spine should never be manipulated as this can cause injury in people with ankylosing spondylitis)
• Hydrotherapy – exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath); the weight of the water helps improve your circulation (blood flow), relieve pain and relax your muscles
• Electrotherapy – electric currents or impulses (small electric shocks) make your muscles contract (tighten), which can help ease pain and promote healing

Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important (see below).

Exercise

The National Ankylosing Spondylitis Society (NASS) provides detailed information about different types of exercise to help you manage your condition.

However, if you are in doubt, speak to your physiotherapist or rheumatologist before taking up a new form of exercise or sport.

Alongside physiotherapy, you will also probably be prescribed medication, such as:

• Painkillers
• Tumour necrosis factor (TNF) blockers
• Bisphosphonates
• Disease-modifying anti-rheumatic drugs (DMARDs)
• Corticosteroids

These are described below.

Painkillers

You may need painkillers to manage your condition while you are being referred to a rheumatologist. The rheumatologist may continue prescribing painkillers, although not everyone needs them, at least not all the time. The first type of painkiller usually prescribed is a non-steroidal anti-inflammatory drug (NSAID).

Non-steroidal anti-inflammatory drugs (NSAIDs)

As well as helping to ease pain, non-steroidal anti-inflammatory drugs (NSAIDs) help relieve inflammation (swelling) in your joints. Examples of NSAIDs include:

• ibuprofen
• naproxen
• diclofenac

When prescribing NSAIDs, your GP or rheumatologist will try to find the one that suits you best and the lowest possible dose that relieves your symptoms. Your dose will be monitored and reviewed as necessary.

Paracetamol

If NSAIDs are unsuitable for you, an alternative painkiller, such as paracetamol, may be recommended.

Paracetamol rarely causes side effects and can be used in women who are pregnant or breastfeeding. However, paracetamol may not be suitable for people with liver problems or those dependent on alcohol (have an alcohol addiction).

Codeine

If necessary, as well as paracetamol, you may also be prescribed a stronger type of painkiller called codeine. Codeine can cause side effects including:

• Nausea (feeling sick)
• Vomiting (being sick)
• Constipation (an inability to empty your bowels)
• Drowsiness, which could affect your ability to drive

Treating ankylosing spondylitis Part 2- click HERE

Warning Over Co-Codamol Tablets

The stronger version is a prescription-only drug

The UK medicines regulator has issued a warning after the wrong strength of tablets was put into some packets of the painkiller co-codamol.





Some packs in batch LL11701, expiry date of September 2014, which should contain 8mg/500mg strength tablets have the higher strength 30mg/500mg tablets.

Wockhardt UK Ltd, which makes the medicine, is recalling the batch.

The Medicines and Healthcare products Regulatory Agency (MHRA) said there may have been a manufacturing error.

The medicine is used as a painkiller for the short term treatment of acute, moderate to severe pain which cannot be relieved by paracetamol, ibuprofen or aspirin alone. It contains codeine.

The MHRA has issued a drug alert to health professionals.

The different strength tablets can be identified by their markings.

The 8mg/500mg tablets are marked on one-side only as "<AB>" - these can be bought over-the-counter.

However the higher strength 30mg/500mg tablets - marked on one side as "CCD30" and marked as "CP" on the second side - are a prescription-only medicine.

Packs, which contain 32 tablets, from the affected batch were first distributed on 30 December 2011.

Just under 39,000 were distributed to pharmacists and wholesalers for onward sale in the UK.

Ian Holloway, MHRA head of the Defective Medicines Report Centre said: "If you have a packet of the affected medicine, return it to your pharmacist who will replace it.

"If you think you have taken the wrong strength tablet, and in the unlikely event that you feel unwell, speak to your pharmacist or GP promptly."

Neal Patel, pharmacist at the Royal Pharmaceutical Society, said: "Patients who may have taken a larger dose of codeine than anticipated may feel more drowsy so should not drive.

"Other possible side effects include confusion, headaches, nausea and vomiting.

"People with pre-existing long term conditions, the elderly or those taking other medicines may be particularly vulnerable to adverse effects and should speak to their pharmacist for advice. However for most healthy adults if only a single dose has been taken there should not be any long term problems."

People with concerns about an affected packet can also speak to the Defective Medicines Reporting Centre on 0203 080 6574.

Original Story bbc.co.uk/news

Stay Mobile & Keep Working

If you have long-term pain, it's important to keep active. If your body stiffens up it can make the pain worse, so resting is not always the best way to deal with pain.

Things You Can Do

Painkillers:
If painkillers help you, take regular pain relief. Use paracetamol as it's safer than anti-inflammatory drugs such as ibuprofen, unless you have a clear injury that occurred in the past few days. Pharmacists can advise you on pain relief and what to do if you're having side effects.

Pain Gone:The Drug Free Pain Relief Pen

Exercise:
Try to do gentle stretches, movements and warm-up exercises throughout the day. Take care not to overdo it. Ask your GP about Exercise on prescription schemes. Your GP can refer you to a fitness instructor at a local leisure centre who will design a fitness programme that is adapted for you.

Pace Your Activity:
Do something active every day instead of only on the good days when you're not in so much pain. This may reduce the number of bad days you have and help you feel more in control.

Osteopaths And Chiropractors Specialists:
May be able to help with short-term pain relief, but it's not recommended that you use these treatments in the long term. It’s important to be able to manage the condition yourself.

See A Physiotherapist:
Physiotherapists use a wide variety of treatments for pain. They also help with posture. For instance, if you have a painful condition, you may lean away from the site of the pain (for example, using a stick or crutch). The longer you lean away, the more difficult it is to get upright again. This can put pressure on the other side of your body and cause problems there. It’s important to use your muscles rather than relying on collars, braces, corsets, tubigrips and wrist splints.
You need a referral from your GP to see a physiotherapist. Physiotherapists are often based in hospitals, but some are available in GP surgeries.


Occupational Therapy Occupational Therapists (OTs):
These are specialists who work with people with long-term pain and give expert advice on how to carry out day-to-day activities in spite of pain. They can assess your home to identify whether devices such as stair rails could help you lead an independent life. They can also advise you on how to get back to work gradually. They can produce a 'graded return-to-work' plan for you and liaise with employers.

Work

It's important to try to stay in work. Research shows that people become less active and more depressed when they don't work. This, in turn, leads people to take even more time off. If your employer is not sympathetic you may need a letter from your GP explaining your condition.
If you've been off work, you could go back to work gradually. This is called a 'graded return'. You may start with one day a week and gradually increase the time you spend at work.
When you do go back to work, take care not to overdo it. Change your position at regular intervals and take proper breaks.

Go On A Course

The Expert Patients Programme is a six-week course for people with chronic or long-term health conditions. You'll work with health trainers who themselves have long-term health conditions. They will help you relax, develop new life goals and work on ways of building up your stamina. Together with the tutors you will develop a plan to help you live with your pain.

What can Your Doctor Do ?

What doctors can do for back pain

There's no quick fix for most back pain and your doctor is unlikely to be able to 'cure' you. However, they will be able to:

• Check you don't have a serious condition
• Discuss your posture and activity level
• If needed, help with a weight-loss programme
• Prescribe another type of painkiller
• Refer you to other health practitioners who can help
• Your doctor will probably give you a physical examination and ask you about your back pain.

Here are some probable questions your GP will ask. Think them through to make the most of your medical examination:

• When did your back pain start?
• What were you doing when it started?
• Have you had any back problems in the past?
• Where is your pain?
• What sort of pain is it - dull, piercing or shooting?
• Does it stay in the same place?
• What makes the pain better, or worse?
• Do you have any other symptoms, in your back or elsewhere?
• What does your back pain stop you doing?
• What have you been doing which might have contributed to giving yourself a bad back?
• What can you do in the future to try and keep your back healthy in the long term?
• If you're not happy with your doctor's diagnosis or if your symptoms keep coming back, go back to your GP or ask another health expert for their opinion.

Which Painkiller?

The type of drugs that you need to treat your pain depend on what type of pain you have.

The type of drugs that you need to treat your pain depend on what type of pain you have.
Dr Alf Collins, a consultant in pain management at Musgrove Park Hospital, Taunton, says everybody who has pain should consider taking painkillers. But different painkillers work better for different types of pain.

For pain associated with inflammation, such as acute back pain or headaches, paracetamol and anti-inflammatory medicines work best.
If the pain is caused by sensitive or damaged nerves, as is the case with shingles or sciatica, it is usually treated with tablets that are also used for epilepsy and depression. These tablets change the way the central nervous system works.
The aim of taking medication is to improve your quality of life. All painkillers have potential side effects, so you may need to weigh up the advantages of taking them against the disadvantages.
Paracetamol, anti-inflammatories and aspirin

Paracetamol: 

Paracetamol is used to treat headaches and most non-nerve pains. Two tablets of paracetamol up to four times a day is a safe dose for adults. Side effects are not common and this dose can be taken regularly for long periods.
Overdosing on paracetamol can cause serious side effects. If the pain is severe, do not increase the dose.
If the pain lasts for more than three days, see your GP.

Anti-inflammatories:

Ibuprofen, diclofenac and naproxen seem to work better when there is clear evidence of an inflammatory cause, for example arthritis or an injury.
They should not be used for a long period unless you have inflammation. When taken for long periods there's an increased risk of stomach upset, including bleeding, and kidney and heart problems. Don't take more than the recommended dose as this will increase the risk of serious side effects.

Aspirin:

Aspirin produces the same type of side effects as other anti-inflammatories, but is not as effective as a painkiller, which means it is not usually prescribed for pain. It is dangerous for children under 12.

Codeine And Other Medium-Strength Painkillers:

Codeine doesn’t work very well on its own. It works better when combined with paracetamol in a single pill. You can buy co-codamol (paracetamol and low-dose codeine) over the counter. Higher dose codeine has to be prescribed.
Other medium-strength prescribed painkillers include tramadol (Zydol) and dihydrocodeine.
All these painkillers can cause dependency, which means that when you stop taking them you may feel unwell for a short period. If you need more and more of these drugs, contact your GP or other healthcare professional for advice.

Amitriptyline and Gabapentin:

Amitriptyline is a drug for depression and gabapentin is a drug for epilepsy. Each of these tablets can also be used to treat pain caused by nerve sensitivity or nerve damage, such as shingles, diabetes nerve pain and sciatica. You don’t have to have depression or epilepsy for these tablets to help nerve pain.
Amitriptyline and gabapentin both have to be prescribed by a GP. Side effects include drowsiness and dizziness.

Morphine:

Morphine and morphine-like drugs (for example, oxycodone, fentanyl and buprenorphine) are the strongest painkillers there are. Some come as a patch, but they all work in similar ways and should only be used for severe pain.
They will only be prescribed after consultation with your GP or a pain specialist. The dose and your response will be closely monitored. These drugs should only be used as part of a long-term plan to manage your pain.