Back pain – whether it occurs in the neck, shoulders or lower back, because of over-exertion, twisting awkwardly, poor posture or lifting incorrectly – can cause soreness, stiffness and tension. And what’s more, it is estimated that 80 per cent of people will suffer from it at some point

The lower back is the nation’s number one sore spot, according to a survey of 1,000 people who experience aches and pains, commissioned by the Simply health Advisory Research Panel (ShARP). But while more than a third of sufferers assume that taking to their beds will ease their symptoms, resting simply prolongs the pain and further reduces mobility. Exercise is proven to improve spinal aches and pains but, according to the survey, only six per cent of sufferers use this method to relieve their symptoms.

“If you suffer with back pain, exercise might be the last thing you feel like doing, but it’s important to try to remain as active as possible as it will help with your recovery,” says Ian Harding, consultant orthopaedic surgeon at Spire Bristol Hospital. “Don’t try anything too strenuous – walking, swimming or yoga can do wonders. Bed rest and being inactive is not advised as it can actually hinder the healing process.”

According to Arthritis Research UK, acute lower back pain (i.e. of less than six weeks) affects four in every five people at some point in their lives. The main symptoms are soreness, tension or stiffness. The pain may also be felt down the front, side and back of the leg. Usually there’s no serious cause and the pain disappears after a few weeks. However, without treatment, lower back pain can develop into a long-term problem. Chronic back pain, lasting for longer than six weeks, affects more than six million people in the UK. It can interfere with work, social lives and relationships and may lead to anxiety and depression.

So why is lower back pain so common, how should it be treated and what advice should pharmacy staff be offering to customers?

Nation at risk

According to the NHS Choices website, back pain can be triggered suddenly by everyday activities at home or at work, or it may develop gradually over a period of time, usually caused by prolonged sitting or standing, or lifting badly.

Back pain affects people of all ages. While it’s common for the back to stiffen as people get older, even children can experience symptoms too. A study carried out by researchers at Swansea University in November 2013 found that 64 per cent of secondary school pupils had experienced back pain, while the corresponding figure for those at primary school was 72 per cent. The researchers blamed technology, such as computers, video games and smartphones, for the trend.

In August 2013, the British Chiropractic Association (BCA) warned that young people are suffering from back and neck pain as a result of leading sedentary lifestyles. According to consumer research conducted on behalf of the BCA, 65 per cent of 16 to 34 year olds have experienced neck or back pain and almost a third have lived with the pain for up to a month. What’s more, over a third admit that their back pain can be triggered by sitting still for long periods of time.

Dr Gill Jenkins, leading GP on ShARP, stresses that lifestyle factors play a significant role in back pain development. “Back pain is probably becoming more common as the nation is less fit, less active and more overweight,” she says. “We all spend too long hunched over computers, which means our muscles are less fit. If we don’t use the back muscles regularly, they weaken and our core strength reduces, so this adds to the burden, causing pain and stiffness.”

Angela Bradshaw, an Alexander technique teacher from Chobham, Surrey, says poor posture directly affects the functioning of the whole body. “How well we are coordinating our head and spine determines our overall health, mobility and ease of movement,” she says. “Sitting for long periods of time is a challenge for the spine, so those who have a sedentary lifestyle are at risk from having back problems. But if you re-learn how to sit well and use your skeletal support system whilst sitting, you can improve your chances of remaining fit and well.”

Management options

The treatment for back pain depends on how long someone has been experiencing the symptoms. Most cases of acute back pain can be eased with simple painkillers (e.g. paracetamol or ibuprofen) as long as these are suitable for the customer to take. Taking painkillers regularly throughout the day (sticking to the recommended dose) should help to keep the pain at bay. However, customers should speak to their GP if their symptoms last for six weeks or more.

“Over-the-counter painkillers can be very useful, particularly for acute episodes,” says Dr Jenkins, “but it isn’t wise to take them for long periods without consulting a GP, particularly if someone has any underlying problems. Hypertension increases with age, as does the incidence of diabetes and heart disease, and it’s important that people with persistent aches and pains discuss their options with a GP, physiotherapist or other healthcare professional.”

For acute flare-ups, Mr Harding suggests using hot or cold compression packs, although a bag of frozen vegetables and a hot water bottle will also work.

Dr Jenkins says that rubbing in topical analgesics or rubefacients may also bring relief, and agrees that some people find that alternating between hot and cold products is effective. Up to 90 per cent of people recover within a few weeks, although the pain may return every so often.

If the back pain lasts for longer than 12 weeks, customers should seek medical advice to check there is no underlying cause (e.g. osteoporosis or arthritis). Red flag symptoms include:

• Unexplained weight loss
• Extreme worsening of pain
• A loss of sensation in the arms or legs
• A loss of bladder control (which could be a urinary tract infection)
• Numbness in the saddle area (implying the spinal cord is squashed)
• Persistent pain in the leg (a sign of sciatica – irritation of the sciatic nerve which runs from the back of the pelvis down to the feet).

Unfortunately the cause of chronic back pain can’t always be identified, so the treatment involves relieving the pain and strengthening the muscles. Most people respond well to a tailor made exercise programme; acupuncture; the Alexander technique (which improves posture and balance); and/or manual therapies such as massage, physiotherapy, chiropractic and osteopathy. Occasionally, GPs prescribe medication such as the antidepressant amitriptyline, which acts as a painkiller in low doses, relaxes muscles and improves sleep. Fewer than two per cent of people with chronic back pain need surgery.

Some research has also suggested that certain food supplements, such as omega-3 fatty acids and rose hip may help people with pain associated with some types of arthritis. In addition, vitamin D and calcium are thought to be beneficial in maintaining the health of the bones.

Keeping fit

According to Arthritis Research UK, exercise is the most important way that people can help themselves if they are prone to back pain. Research shows that regular exercise leads to less frequent and shorter episodes of back pain and also releases endorphins (the body’s natural painkillers). In the ShARP survey, over 50 per cent of people admitted doing nothing to help their musculoskeletal health on a day-to-day basis, despite being fully aware of what exercises they should be doing (e.g. swimming, yoga and pilates).

“The medical profession prescribes medicines to improve the pain, but this is only a short term fix,” says Paul Holbrough, physiotherapist and ShARP member. “It’s important to strengthen the muscles as well. There is a real danger that people can become trapped in a vicious cycle with a lack of exercise leading to increased stiffness, pain and muscle wastage and therefore less support for the spine and an increased risk of problems. On top of that, reduced activity increases the likelihood of weight gain, which places even more stress on our joints.”

Exercise may make the back feel a bit sore at first but it doesn’t cause any harm. Customers should start off slowly and gradually increase the amount of exercise they do.

Over time, their back will get stronger and more flexible and this should reduce the pain. It’s better to choose a form of exercise that they enjoy as they are more likely to stick to it. It’s common for some people to stop exercising once back pain has cleared up. But if they stop exercising, all the improvements to their physical condition disappear within a few weeks.

“Yoga and pilates once or twice a week is massively beneficial,” says Paul. “Suggest that people go to classes initially to learn techniques that they can do at home. Once people realise exercise is why they are no longer in pain, they may start doing it naturally to improve their posture. It’s important to speak to someone who understands body mechanics, such as a physiotherapist, so they can assess the situation and recommend the right exercises. If people join a gym, they are not necessarily being advised by someone who is trained to see why they are getting the pain.”