Living your life don't take your back pain lying down.

You've probably experienced low back pain at some stage in your life. Many of us have. Short term low back pain is common--in fact, more than seven out of 10 New Zealanders will experience low back pain at some stage in their lives.

"One of my patients, Rachel, is a registered nurse in a psycho-geriatric ward, which requires her to lift patients frequently, often in quite awkward postures. The DHB has well established strategies to prevent serious back injury, such as lifting aids, handling training, and procedures for handling patients. Such primary prevention strategies are important to avoid preventable serious back injury, but do not prevent many cases of acute low back pain. Partly this is due to the risks of injury from other causes such as catching a falling patient, trips or restraining a patient who has become agitated. The most important issue is that simple acute low back pain is not preventable whatever interventions are in place, because it is an idiopathic pain disorder rather than biomechanical injury, and episodes will continue to occur, even in the absence of any identifiable causative or provocative event.

Rachel developed acute tow back pain while she was working nights, and the extra effort to work at night may have played a contributory role, but she could not relate her pain to a specific incident. The pain was intense, and persistent for several weeks, but there was no radiation down the leg, and no weakness or numbness. However, her principal concern was the risk that the lifting demands of her work might aggravate or prolong her back pain. In consultation with her general practitioner, Rachel discussed options for pain relief. As a health professional, she knew the importance of staying mobile and during her two weeks off work, had been swimming regularly, and avoiding bed rest. She and her GP agreed that additional pain relief might be needed during the first few days and weeks back at work. In addition to a regimen of regular non-steroids anti-inflammatory drugs, a stepwise approach to analgesics was effective, so that additional analgesics were used to prevent pain and stiffness while working on the ward.

What is most important is to have a plan for progressively increasing physical activity, including at work. Rachel was assiduous in increasing her laps at the pool based on a plan agreed at the beginning, right from day two of her back pain episode. Her GP proposed a return to work plan which involved no patient handling for two weeks, for a period starting two weeks after pain onset (which is a longer than average period of incapacity). After this she was advised not to lift patients and to be meticulous about the use proper handling techniques, and to call on assistance from others where deemed necessary. Her first shift rostered on nights was difficult, due to staff shortages and wandering patients, but she coped well. While she needed additional analgesics during this period she was aware that pain did not equate to injury, so therefore she continued to work almost normally.

At six months, Rachel is working unrestricted activities, and can lift without pain or weakness. She is aware of some niggling pain at the end of a shift or after heavy lifting, but accepts that this is normal. As her work involves bending, stooping and lifting, Rachel knows she is at risk of a second episode of acute low back pain, but has been reassured that this will resolve as quickly as the first, if it does occur. As the principal breadwinner Rachel is pleased to be back at work and not incapacitated, as at first she feared she might be."

If you've recently experienced a serious back injury, or have warnings of a potentially serious disease, more specialised advice is required. You should also visit your doctor urgently if your back pain is associated with numbness in the groin or anal area, or you have difficulty in walking or going to the toilet.

THE FACTS

Back pain does not mean you have an injury (unless you have had some major force on the back).

Most work, even in jobs that are physically demanding, can be modified to accommodate the abilities of a person recovering from acute low back pain; assessment should focus on what they can do, not what they can't!

Set a plan for progressively increasing the range and extent of things you can and will do, both at work and at home; once you have that plan, stick to it! The pain may well increase slightly as you get back to more demanding work, but this does not mean that you are harming any part of your spine.

Living your life, not the pain, is the key to recovery--use regular pain relief to support the things you want to do!

Dr Robin Griffiths, an occupational medicine specialist and Chairman of the Back Pain Expert Panel which developed the best medical practice guidelines for acute low back pain, provides a real life story in the health sector.