GP, Alice Fitzgibbon continues her back pain focus

In part two of our back pain focus, GP Alice Fitzgibbon looks at more serious and underlying problems that cause back pain, in association with ToughBuilt

Last month’s column covered the very common condition of muscular lower back pain. This month we move on to back pain caused by reasons other than muscle problems. Back pain caused by serious medical conditions represents a very small number of cases, but it can be a sign of conditions like infection or cancer happening inside the body to cause pain that is felt in the back.

This article will cover symptoms that might indicate a more serious underlying reason for having back pain. That doesn’t mean to say that experiencing these symptoms means there is definitely a serious problem, but it should prompt you to seek help or the medical professional assessing you to consider some further tests.

There are two categories of symptoms; symptoms that mean you should have an urgent review with a medical professional and then symptoms that are a medical emergency – meaning you need to go to A&E or call 999.

So, firstly, the urgent symptoms. These are back pains associated with:

• Having a high temperature
• Feeling generally unwell or extremely tired
• Losing weight unintentionally
• Change in shape of your back or noticing any new lumps or swellings
• Pain that is worse at night or that does not get better with rest
• Pain that is worse with coughing, sneezing or moving your bowels

Pain in the back that is felt higher up in the “thoracic region” (or the upper back) is also more unusual than lower back pain and might indicate a non-muscular cause.

If you have any of these symptoms, then you should seek urgent advice from your GP or NHS 111 who will be able to assess you. It is likely an examination will be needed, and further tests might be arranged to find out exactly what is going on.

Back pain is a medical emergency when there are signs that there might be something pressing on the bottom of the spinal cord (called the cauda equina).  Prolapsed discs in the spine, collapsed bones or tumours growing can all cause what is known as “cauda equina syndrome”. The specific symptoms associated with this condition are back pain with:

• Pain, numbness, altered sensation or weakness in both legs
• Numbness or tingling around the genital area or buttocks
• Struggling to pass urine (being unable to go for a pee despite trying)
• Loss of control of the bladder or the bowels (incontinence).

Cauda equina is an emergency and assessment must not be delayed. If it is suspected, an examination and a scan of the back is required in hospital. Surgery may be needed to relieve the compression of the spinal cord to prevent permanent damage to the nerves supplying the bladder, bowels and legs.

As I have mentioned, sinister causes for back pain are far less common than muscular causes. It is important to be aware of the symptoms to look out for, especially as symptoms can change over time. If you experience back pain with any worrying features, or you feel your symptoms are changing over time, then please seek review with a medical professional, whether that be your primary care team or physiotherapist. Next time, in the final article on back pain, we will cover more on pain caused by ‘slipped discs’ and sciatica.

For further information on back pain from the NHS visit Back pain – NHS (www.nhs.uk).

Carrying on from the idea of staying in good health, ToughBuilt’s #KneelSmartKneelSafe campaign aims to see kneepads treated with the same sense of necessity on the jobsite as other forms of PPE like eye protection, hard hats or safety boots. After all, the consequences of not wearing kneepads can be every bit as devastating. ToughBuilt’s ultimate aim is to reduce the number of people who inadvertently end up with work related knee injuries.