Dr Kathryn Fox is an Australian medical doctor and bestselling crime writer, best known for her forensic thrillers featuring pathologist Dr Anya Crichton. Drawing on her medical expertise, she crafts gripping, authentic crime fiction and is also a passionate advocate for forensic medicine education and public engagement.
“I’ve got this terrible low back pain. I saw two doctors and neither of them did anything. No X-rays or scans, they just told me to keep walking and it would get better in time. I’m in severe pain and no one’s taking me seriously.”
Every medical TV show has led us to believe that successful treatment depends on immediate investigations. Urgent Bloods, ultrasounds, X-Ray, CT, MRIs – on American TV, everything is ordered “stat!” Patients in pain are always prioritised and rushed to diagnosis for speedy treatment.
Unfortunately, not every acute problem needs investigation, and some things get better by themselves, without intervention, as frustrating as that can be as a patient. This isn’t guess-work by the doctor. It’s evidence-based thanks to extensive research studying patients and outcomes based on investigations and treatments, which help determine the clinical guidelines. That is what doctors are obliged to follow, to deliver best patient care.
According to an article in the Australian Journal of General Practitioners, non-specific low back pain is the second most common cause for seeing a GP.
Pain is frightening, particularly if it comes on suddenly and won’t ease. You think that if you’re not being sent for some type of body imaging then your pain is being dismissed as trivial. If you’re not prescribed strong painkillers, does the doctor think you’re seeking opiates? Or do they think the pain is in your head?
This couldn’t be further from the truth. Most people will experience acute (short-term) low back pain some time in their lives. And this is the part that patients don’t always like to hear. Diagnosis is made by listening to the patient – medical history, the type, location and nature of the pain and any accompanying symptoms are as essential as the physical signs and neurological examinations. Fewer than one in a hundred people with back pain have a serious cause such as a fracture, infection or space occupying lesion. And in those cases, history and examination will usually raise alarms and lead to a different pathway of investigation.
No one is saying that non-specific back pain isn’t severe. What is important to know, though, even if the pain may seem worse on moving, movement won’t cause any damage. Trying to do as many normal daily activities as possible speeds recovery.
According to RACGP guidelines for treatment, movement helps recover normal range of motion, reduces pain, and helps you get back to work and normal activities more quickly. In other words, bed rest can make pain last longer, prolong recovery and lead to more long-term problems.
It’s important to see a doctor urgently if you develop any of the following:
-Difficulty passing urine,
-loss of bladder or bowel control,
– numbness or tingling between your legs or buttocks,
-feeling like you need to pass urine that isn’t there,
-impaired sexual function – loss of erections or sensation,
-significant loss of power, or a change in sensation in both legs,
-fever.
The first rule of medicine is ‘do no harm’. In most cases of back pain, a scan won’t show the cause of the pain but exposes you to radiation. Scans often show ‘changes’ that are due to normal ageing and degeneration. It’s easy to misinterpret these changes as the cause of the back pain, which leads to further tests, procedures and treatments that don’t improve recovery but come with potential harm and side-effects.
Some doctors order tests to ‘reassure’ the patient but in practice, it may do the opposite.
The purpose of pain medications in lower back pain isn’t to stop you feeling any pain, but to reduce pain so you can continue functioning. Masking all feeling can have adverse effects, affect breathing, cause severe constipation – something even more distressing with back pain – and disguise changes that should be detected immediately. Anti-inflammatories are often used short-term while you increase movement. In keeping with current Therapeutic Guidelines, anything taken should be in the lowest effective dose for the shortest possible time.
Heat in the form of packs, or hot showers can also provide relief. If you’re a side sleeper, putting a small pillow between your legs can also help reduce pain.
Start with gentle walking then increase to light exercise. Gradually increase the amount of physical activity. Going hard and ignoring pain isn’t a solution and can set recovery back. It may feel as if things are going well so you push harder but sticking to a plan is best to avoid setbacks.
Therapies provided by physiotherapists and chiropractors can guide and review your progress. Long-term, improving core strength, back mobility and leg strength all help to prevent further episodes. The back doesn’t work in isolation and may signal weakness or reduced mobility in other parts of the body as well. Prevention is as vital as treatment to well-being and ongoing function and quality of life.
If the pain worsens, or you develop any new symptoms, it’s essential to get medical attention.
IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.
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