Your Health is Your Wealth: Lower back pain and sciatica

Back problems are common, with approximately 8 out of 10 people experiencing back pain at some time in their lives. In most cases the cause is not serious and, with the right guidance and support, people recover without the need for specific treatment or specialist help.

If you are having trouble coping with your back pain or are not managing to gradually return to normal activity, you need to see your doctor to assess your problem and provide advice.

How to manage low back pain?

Low back pain can be helped by many things that you can do for yourself. The best advice is to keep gently active, even if it causes some extra pain. Taking pain relief regularly is important to help you keep moving and in most cases paracetamol or anti-inflammatories are best.

What is Sciatica?

Sciatica is pain that travels down the back of your leg due to pressure on a nerve in your lower back. The pain in the leg is often more severe than the back pain and you may also notice tingling, numbness or weakness in your leg or foot. The early management of sciatica is very similar to managing low back pain and involves keeping moving. It may also be important to discuss what medications are best for relieving sciatica with your doctor.

Are scans necessary for low back pain?

If you have had back pain for less than 12 weeks X-rays and other scans such as CT and MRI are not required. If after four weeks your sciatica is severe, your doctor may recommend scans.

There are some exceptions to these rules and if your doctor has particular concerns, scans may be requested at an earlier stage.

What if the pain continues?

If your back pain is not improving and your pain is severe enough to consider surgery, your doctor may refer you to a specialist or to a hospital. Quitting smoking and losing weight can help your recovery from back pain and also reduce risks associated with having an operation.

When to go to your doctor for low back pain

Occasionally, back pain can be the result of a serious problem. It is important to seek medical advice immediately if you have any of these symptoms:

 Difficulty passing or controlling urine.

 Poor control of your bowels.

 Numbness around your back passage or genitals.

 Numbness, pins and needles or weakness in both legs.

 Unsteadiness when walking.

 Unexplained loss of weight.

 Night sweats, chills, fevers, nausea/ vomiting or unrelenting night pain.

Managing low back pain and sciatica

 Stay active – don’t rest for too long with low back pain

 Bed rest may be needed for sudden and severe pain but only for a very short time, generally no more than two days. Too much bed rest lengthens recovery time and prolongs pain.

 Talk to your doctor about what medication is best for you.

 Keep doing your everyday activities and remain at work

 Back pain and sciatica need not stop you from doing all of the things you want to do. Be aware of the activities that make the pain worse and avoid things like excessive lifting and staying in the one position for too long.

 Exercise for low back pain recovery

 Staying gently active through stretching, gentle exercising and walking will help your back to recover. Begin to exercise regularly, for short periods of time and gradually increase the amount you do as it feels more comfortable.

 Movement helps to stop you back becoming stiff and your muscles from weakening, allowing you to return to normal activity as soon as possible. Even if movement causes some extra pain you will not be harming your back.

 Quit smoking to assist recovery from low back pain

 Smoking can slow down and interfere with the healing of bones, skin and other body tissues. This means that your recovery time can be slower or less complete if you smoke. If you do require an operation, you will have a much higher risk of complications during and after your surgery. Doctors strongly recommend you should at least eight weeks before an operation.

Scans and low back pain

While back pain can be very painful and disabling, less than 1% of cases are serious. If your doctor has particular concerns, they can request scans earlier.

If you have had back pain for less than 12 weeks, x-rays and other such scans are not recommended.

When scans are not required for low back pain?

 Most scans find no abnormalities or only minor changes.

 People with or without back pain show similar ‘wear and tear’ (arthritic changes).  Scans do not improve your pain or help you to recover.

 Unnecessary x-rays and CT scans bring risks of radiation exposure.

When scans are recommended for low back pain?

 Your doctor suspects a serious underlying condition in specific muscles in your leg or foot

 Your doctor believes you have nerve compression related to a disc herniation (pushed outside its normal position) which has been present for more than four to six weeks and is severe enough to consider surgery

 Your doctor believes your symptoms are related to pressure on nerves caused by narrowing of the spinal canal (spinal claudication). Scans may then be recommended if your pain has been present for several months and is severe enough to consider surgery.

Costs of scans for low back pain

In most cases a MRI is the preferred imaging option. General practitioners can refer patients for a self-funded MRI with an out-of- pocket cost of between $150 and $300. Individuals are advised to contact radiology providers directly to confirm expenses.

Public patients referred from a specialist in an outpatient clinic can obtain imaging at no out- of-pocket cost.

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