Back pain is an incredibly common ailment and is one of the most common reasons people visit their doctor. It’s likely that you or someone you know has experienced back pain at some point in life. Research carried out by Public Health England suggests that approximately 1 in 6 people in England have back pain, though realistically, this figure is very likely to be much higher than this. Back pain is commonly misdiagnosed and brushed off as nothing serious, but in some cases, it can be a cause for concern. Lower back pain is most common in females aged between 40 and 80 years of age. For many people it is a recurring issue and unfortunately can have a huge impact on quality and enjoyment of life. But when does lower back pain require a rheumatologist? Here, we take a look at what causes back pain and when to seek a rheumatologist for support.
What causes lower back pain?
For the majority of people with lower back pain, the cause is usually something minor, a muscle strain or issue with the ligaments surrounding the spine. But back pain can be a cause for concern. The important thing is understanding when to seek help.
Back pain is a complex issue and there is no single cause. It is usually classed as either acute or chronic:
- Acute back pain is usually a sudden onset of pain for a short period of time and is usually the result of an injury like a pulled muscle or slipped disc.
- Chronic back pain is categorised as pain that lasts for three weeks or more and has not improved or has gotten worse. According to the National Institute for Health and Care Excellence (NICE), between three and four percent of adults aged 45 or under have chronic lower back pain, and five to seven percent of adults over 45 have chronic lower back pain.
Reasons for lower back pain
When it comes to lower back pain that is not getting better (or is getting worse) there are many underlying conditions that could be causing it. These include osteoarthritis, osteoporosis, ankylosing spondylitis. Each of these conditions require different approaches to care and management as they are degenerative diseases that will continue to worsen if not treated appropriately.
Let’s take a look at these three conditions in a little more detail:
Osteoarthritis
Osteoarthritis is a disease of the joints that causes pain as a result of the breakdown of the cartilage and bone in the joint. It can lead to a grinding sensation in addition to pain in and around the affected joint. NICE estimates that around 10 million people in the UK have osteoarthritis. Individuals with this condition will usually experience stiffness in the joints and swelling, particularly in the morning or after resting. Osteoarthritis is commonly found in the knees, hands, and hips but it can also affect the lower back, although less common.
Osteoporosis
Osteoporosis is incredibly common and women are at far greater risk than men. In women, osteoporosis prevalence increases from just 2% at 50 years of age to around 50% at 80 years of age. Two million women have osteoporosis in England and Wales, according to NICE. This bone disease makes the bones less dense, making them weaker and more fragile than normal. This means they are more likely to fracture and for individuals with the condition to experience broken bones. It is very common for individuals with osteoporosis to break their wrists, broken hips, and even the vertebrae in the back. Often, individuals will not be aware they have the condition, and a broken bone is usually the first sign of osteoporosis. Broken or collapsed vertebrae in the spine can cause severe lower back pain and can lead to stooped posture and loss of height.
Ankylosing spondylitis
Ankylosing spondylitis is far less common than osteoporosis and osteoarthritis and there is much less data available on this condition and its prevalence in the UK. For individuals with ankylosing spondylitis, stiffness and pain in the lower back are usually the main symptoms. The pain usually improves with exercise but it’s likely to get worse with rest so it is vitally important to stay gently active. Those with ankylosing spondylitis may also experience pain and stiffness that is worse in the morning and before going to bed. There is a lot of variation in terms of how severe the pain is; some individuals can experience sudden pain and for others it can be more consistent, but often the episodes of pain come and go.
Managing lower back pain at home
There are steps you can take to manage lower back pain at home, including:
- Maintaining good posture, which is essential for preventing trapped nerves and back problems
- Take anti-inflammatories such as ibuprofen (as indicated on the packet) to help manage pain
- Weight management – being overweight is a considerable contributing factor in back pain, and maintaining healthy weight can help reduce the risk of back pain
- Heat can be used to help stiffness in the lower back and cold can be utilised to reduce pain
- Gentle exercise to keep the back mobile
Back pain – when to worry
In the majority of cases, back pain will improve within a week or so. If it doesn’t, or is accompanied by any of the following symptoms, you should seek advice from a healthcare professional as soon as possible.
- Long term back pain that doesn’t improve in 3 weeks
- Pain that is unbearable and stopping you from doing normal activities
- Pain that continues to get worse
- Fever alongside the pain and/or temperature
- Tingling or weakness in your limbs
- Sudden weight loss
What does a rheumatologist do and how can they help?
Rheumatologist is a specialist practitioner that diagnoses and treats all conditions involving the joints, muscles, and bones. They also are specialists in the management of inflammatory health conditions of the musculoskeletal system. Some of the more common conditions that a rheumatologist treats includes rheumatoid arthritis, osteoarthritis, osteoporosis, ankylosing spondylitis, and other autoimmune diseases affecting the joints.
A rheumatologist will combine an examination with details of your symptoms, and your medical history, your family medical history, and any relevant imaging (i.e. X-rays and MRIs) where necessary. This will allow them to get a good understanding of the affected joints and provide you with an accurate diagnosis from which they can treat your condition effectively. Unfortunately waiting lists for public healthcare in the UK are long and it is not uncommon to wait between six and twelve months to be seen. If your symptoms are affecting your quality of life you might prefer to seek the advice of a private rheumatologist. If you are looking for a private rheumatologist, Pure Rheumatology London is an experienced rheumatology clinic with expert consultants ready and waiting to help you recover and restore your quality of life.
