Acute pain is a completely new pain or new pain episode in an area where you have had pain before.
Chronic pain does not refer to the severity of the pain but the duration. It is pain that lasts for longer than 3 months.
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Acute pain is a completely new pain or new pain episode in an area where you have had pain before.
Chronic pain does not refer to the severity of the pain but the duration. It is pain that lasts for longer than 3 months.
Exercise is the best way to improve back pain. The world wide recommendation for adults is at least 2 strengthening exercise sessions per week.
Strengthening exercises are those that involve using your body weight or lifting weights. Examples of exercises using body weight are press-ups, squats and lunges.
Other ways to strengthen your body are – ball games, racket sports, dance, and Nordic walking.
Strengthening exercises especially good for the back include bridge, planks – front and side, squats, lunges, and dead lifts.
The most important element is that you enjoy the exercise you take part in. The actual exercise you do is less important.
Arthritic changes are very common. Most people over the age of 50 will have signs of arthritic changes in their neck. 50% of people over 60 years of age will have arthritic changes in their lower back.
We now consider arthritis is normal ageing. Just as you get older on the outside, you get older on the inside. Having used your body for many years there are going to be signs of that use internally.
Not everyone gets pain with arthritic changes but some people have pain that really affects their daily life – aches and pains, difficulty with movement, bending and lifting.
Osteopathy can help with arthritic pain. Some people may have pain because their muscles are deconditioned. Strengthening exercises can really help to relieve arthritic pain. As with any pain, arthritic pain will be worse if you are going through a stressful period, tired and not sleeping well, and if your general well-being is not good.
Osteopathy can help with hands-on treatment to increase comfort around the affected area and provide exercise and well-being advice.
When back pain comes from a kidney infection it typically starts from over the kidney region, just above your waist and may radiate to the groin. The pain can be deep and may come and go.
You may also have a temperature, blood in your urine and feel sick or generally unwell.
A key indicator is that the back pain is unaffected by movement of your lower back – it remains the same no matter how you move or sit.
If you are concerned you may have a kidney infection you should make an appointment at your GP practice.
The quick answer is – Yes. Stress can cause pain in muscles and joints anywhere in your body.
Low back pain, particularly long-term back pain is surprising. Many people link back pain to poor posture, in fact there is very little correlation between posture and people who experience pain. If I want to predict a time when you are vulnerable to a pain episode it will be when you are stressed and/or tired.
The reason for this correlation is probably due to chemical changes in the body caused by stress hormones. However it is clear that stress and low back pain are linked.
From my clinical experience there are two common types of stress that I see patient’s with low back pain experiencing:
Overwhelm stress – this is the stress of being so busy, no time to look after yourself. Perhaps lots of extra things happening in life. The common metaphor is having a full plate. These people are just concentrating on keeping going – keeping everything balanced on the plate. There is a sense in which they are holding on tight or pushing on and this leads to physical tension and pain in the low back.
Unresolved stress – this is the stress from major life events, most commonly bereavement but it can be other stressful events that cause a large change in your life. Often these people have just ploughed on through the difficult circumstance but not actually acknowledged and dealt with the emotions of the situation. The pain associated with these situations can come out months or even years after the provoking event. This may not be until you eventually relax or get to a situation where you can be in pain and you can give your body some attention.
I cannot emphasise enough that when pain has an emotional context it certainly doesn’t mean the pain is not real or all in your head. The pain is definitely very physical with muscle tension and restriction of movement and physical treatments will often make a significant difference. However the pain may not improve long-term without recognising and taking positive action to improve emotions associated with the pain.
One of the keys is simply acknowledging what the stress is and the role it might have in your pain.
Coping with a plateful of stress that is ongoing can have several solutions. You could share the food so someone else takes some of the burden. You can simply take off some of the food. You may need to get a bigger plate so it seems more manageable. This may mean putting in place some self-care so that you have greater resilience to manage everything on your plate.
When pain is associated with a significant life event acknowledging and talking about feelings linked with that event can be very important. Tell someone about your emotional pain, anger, disappointment, numbness – whatever your feelings are about the situation. The person often simply needs to listen, not offer solutions. Perhaps your body is telling you it is time to take a break and allow yourself to relax.
Maybe your high stress levels are indicating that you need to make some changes to improve your general well-being – exercise, healthy eating, less caffeine, relaxation, improving sleep and so on.
Come and talk to me in clinic if you want to explore if there may be underlying factors relating to your pain. My comprehensive assessment often enables us to identify several factors that may be contributing to your pain.
Exercise is one of the most helpful things you can do to improve pain and general well-being. The worldwide recommendation is to do 2 strengthening exercise sessions per week involving all major muscle groups. This includes legs, hips, back, chest, abdomen, shoulders and arms. One set of 8-12 repetitions is effective though you may benefit even more from 2-3 sets. You should allow at least 48 hours to recover between strength training sessions.
Strengthening exercises include ball games, racket sports, dance, Nordic walking, exercises using your body weight or lifting weights. Examples of exercises using body weight are press-ups, squats, planks and lunges.
When you have low back pain it can be very difficult to sit on certain chairs or sitting can feel like it brings on pain and you might not be able to sit for very long at all. Let’s look at why this might happen and what you can do about it:
Sometimes your body can become sensitised to certain positions. If your pain came on when you moved whilst sitting or if the pain came on after a day of being very sedentary and sitting you may find sitting uncomfortable. This is your body trying to protect you from harm – last time you sat you ended up in pain so your brain triggers a pain response to try to make you move and prevent the painful situation occuring again.
Sitting is a similar movement to bending forward. If your acute pain came on as you bent forward then a sitting position may be interpreted as a threatening position because it is so similar.
If the pain is making you feel tired and miserable it may simply be that you don’t want to be in that situation – at work, in a meeting. Sometimes those emotions will trigger pain to enable you to leave that situation.
Sometimes it can be predictive. People’s beliefs are extremely powerful. If you believe that sitting on a certain chair or in a position will bring on your pain it almost certainly will.
Continuing with beliefs – a lot of people have beliefs about certain chairs. You may associate your pain with sitting on a soft sofa. You may believe you should only sit on hard chairs. Again these beliefs will tend to be predictive of your pain response.
Sometimes hard chairs will feel better. One of the reasons for this is that you can have more varieties of sitting positions – sitting, leg crossing, slouching, leaning to one side or the other. On a softer seat you can tend to sink into one position for longer.
As with any position – if you spend too long doing any one thing it will often bring on pain. This is particularly emphasised if you are having a pain episode. The key, as I often mention, is to move regularly.
Sitting will not cause harm or damage in your back. If you are getting pain you need to think about why. Is it because you haven’t moved for a while? Is it because you believe that chair will cause you pain? What are your emotions about the situation you are in? Addressing some of these factors and reassuring yourself that you are not causing harm, alongside regular movement can make a big difference.
Whilst sitting you can introduce a movement exercise by bending from side to side several repetitions or alternating between a slouched position and upright to move your lower back for several repetitions.
When sitting is uncomfortable it can be helpful to limit your sitting time. For example decide how long you can sit for without too much discomfort – perhaps 2 minutes. When you sit down set a timer for 2 minutes and then get up and move. Gradually increase the time you sit for – maybe 3 minutes then 5 minutes, then 8, then 10 etc. Make sure that you are not simply sitting there waiting for your pain to come on. Focussing on the pain is not helpful. Sit down and do something. When the timer buzzes move, no matter how you feel. Sometimes it can be tempting to sit for longer if you feel ok but this may be unhelpful until you are confident that you can last longer without increasing discomfort. The risk is you will make your pain yo-yo between highs and lows whereas we are aiming for more of a plateau.
Try one or two of these ideas and see if you can improve your symptoms relating to sitting. Some people struggle getting up from sitting although they are comfortable sitting, this is something we will consider in a future question.
To answer this question I am going to use the results of some Cochrane research reviews. These reviews gather together the results of lots of research projects on a subject to provide evidence based healthcare advice. Usually the experiments compare the gel to a placebo (fake) gel. If the gels give the participants significantly pain relief and substantially more than the placebo treatment they are considered effective.
Using diclofenac gel (voltaren), ketoprofen gel, ibuprofen gel or diclofenac plaster on acute (new) pain.
7-8/10 people with a painful strain, sprain or muscle pull had much reduced pain after 7 days. 2-3/10 had the same effect with a placebo gel.
All other gels are not much better than placebo for acute pain.
Conclusion: Voltaren or ibuprofen gel may help with relieving a new painful strain, sprain or muscle pull.
Diclofenac gel (voltaren) and ketoprofen for 6-12 weeks reduced pain by at least half for a modest number of people.
The gel needs to be used for a long period to reduce pain for some people with OA.
Heating and cooling gels do not make enough of a difference for researchers to be able to recommend them. They are probably more likely to have an effect in acute pain than chronic. This does not mean they won’t work for you but it means that they do not make a big enough difference for a significant number of people compared to placebo for relieving pain.
Capsaicin helps about 10% people who are experiencing nerve pain. It is most often used for the nerve pain that can linger after shingles.
As you can see the results are mixed. The research compares the effectiveness of the gels to placebos. For some people a placebo gel produces a positive effect. It may be worth trying the gels to see if they work for you. Even if it is a placebo effect. If it gives you some relief it can be worth it.
References
https://www.cochrane.org/CD008609/SYMPT_do-painkillers-rubbed-skin-really-work
Have you ever asked this question about gels or creams? There are many pain relief gels and creams available -some work by heating, others cooling and some claim analgesic (pain relief) effects. You will see shelves full of gels in the supermarkets and pharmacies it can be bewildering.
There are lots of different types of gels which work in different ways:
Pain killing gels include voltaren gel (which contains diclofenac) or ibuprofen gel. These gels interupt the production of chemicals in the cycle that causes inflammation and therefore reduce the amount of pain felt in an area. All NSAID painkillers including tablets, such as neurofen, aspirin and ibuprofen, work in a similar way. There are less side effects with applying gels to the skin compared to taking tablets.
Salicylates are heat gels. They cause heat by local skin irritation. It is not known how they actually do this.
Cold gels contain menthol which triggers cold receptors in the skin.
Capsaicin is the active ingredient from chilli peppers that makes them taste hot. It’s not known exactly how capsaicin works but it is thought to reduce the chemical that transmits signals along sensory nerves to the brain.
There can be redness at the site of application. Around 1 in 20 people experience this mild, short-lived symptom. It is uncommon to get stomach upsets or feeling sick with gels.
Capsaicin causes side effects, mostly skin irritation, in 4 out of 10 people.
These gels seem to be very subjective in terms of their effectiveness. Some patients have amazing results, for others they do nothing. When patients ask me about which gel or cream to use I usually ask if they have used any before and found them to be effective. If so, I recommend using the same gel again. If the patient has no experience of them I usually say, it’s worth a try, whichever one they like. I’ll be answering this question in more detail soon.
£42 per session. The next question is usually how many sessions will I need? I understand you are making an investment in your health and you want results.
I don’t keep patients coming if they are not seeing results from treatment. If you have complex symptoms I often agree with you to have a trial of around 3 treatments and then reassess whether you want to continue.
Many people are reluctant to invest in themselves. But, if you are like me you will probably spend a few £100 on keeping your car on the road each year. In my opinion good health is invaluable and should be a priority in your life – how do you feel?
It’s difficult to say how many treatments will be needed. As a generalised guide though, for persistent long-term pain we often reach treatment goals at around 6-8 sessions. I will usually try to give an estimate at your first session.