What can be done when back pain suddenly strikes? It is helpful to know what pain is, and first aid measures that can be taken at home or at the office before seeking advice. This note assumes that back pain is musculo-skeletal, and does not have a pathological, systemic or infective cause. If it persists for more than a few days advice should be sought.

Pain

Pain is felt if the body is damaged; but pain can also occur as a warning that the body is under strain and, unless care is taken, damage might occur. Hurt is not the same as harm.

Pain can be due to physical, emotional and psychological causes. Often the immediate cause of back pain can be an ordinary everyday movement such as bending to pick up a piece of paper or twisting to get something from the back seat of the car. Back pain does not have to be caused by heavy lifting or unaccustomed physical activity.

Sometimes back pain can have longer term causes such as poor posture or repetitive tasks. It is rarely caused by muscle weakness. Even top sports people have back pain, and they are generally extremely fit and strong.

But whatever the cause, the effects on the body of sudden back pain (besides the painful feeling) may be an initial immediate protective muscle spasm, leading to a ‘bent’ or protective posture. Then, inflammation follows as the body tries to send healing chemicals to the area to protect and repair any damaged tissue. The blood flow to the area may be reduced because of the swelling and tight muscle spasm that protects the area by preventing movement.

First Aid: What to do and why

Hot and Cold
The first thing to do is to apply cold treatments to slow down the inflamatory process. Most people find cold treatment is effective, but some prefer alternating hot and cold, which acts to boost the blood supply to the area, thereby promoting healing..

Cold treatment does not need to be a special cold pack. A can of drink from the fridge or a packet of frozen peas, wrapped in a damp tea towel and placed on the pain will do the job. A hot water bottle or a heated damp cloth will suffice for heat treatment.

For cold treatment, apply cold for five to ten minutes, and then take it away for ten minuteand repeat. This should be repeated hourly if needed.

Hot and cold treatment consists of three minutes of heat followed by one minute of cold; then apply three more minutes of hot and one of cold, and again repeat hourly. These times are approximate.

Anti-inflammatories
Anti-inflammatory pain killers such as neurofen or ibuprofen can be taken as these also reduce inflammation.

Relaxation
Relaxation is important, as fear or anxiety can heighten sensitivity to pain. Quiet breathing and calm will reduce the body’s stress response, in turn improving blood flow to the painful area. Anxiety and tension lead to more muscle tightness and more pain.

Restoration of Mobility

Bed rest is no longer thought to be helpful as muscles become stiff. The back has much better blood flow if it is moving, and muscles will begin to relax with gentle movement. Just getting up and down, if possible, and walking round the room every few minutes will help much more than lying flat for a long time.

If after a few days the pain has not reduced and mobility is not improving, it is important to seek professional advice.

Articles & Resources

The Back Book: the best way to deal with back pain. The Stationery Office, London (2002). 21 pp www.tso.co.uk

BackCare: the independent national charity that helps people manage and prevent back pain. 16 Elmtree Road, Teddington, Middlesex, TW11 8ST (020 8977 5474) www.backpain.org