One in 5 living with undiagnosed back pain

One in five people in the South West (19 per cent) are suffering from debilitating lower back pain and do not have a diagnosis for their symptoms.

This is leading to widespread anxiety, depression and avoidable time off work, new research suggests.  

The figures out this week from Nuffield Health reveal that the combination of a lack of access to treatment and diagnostics, poor guidance for doctors as well as sedentary lifestyles are causing a large number of people in the South West to live with painful symptoms which could be avoided with early treatment and good advice. 

Nuffield Health questioned 306 people in the South West and more than a third (38 per cent) said they suffer lower back pain which impacts on their daily life.

Of these:  

• One in five people in the South West (19 per cent) have never had a diagnosis and do not understand why they have pain or how it could be treated. 
• Nearly half (49 per cent) have been told that there is no point in a referral to a specialist as there is no treatment for lower back pain.
• Over a quarter (26 per cent) have not had access to any form of diagnostic scan – MRI /CT or X-ray to investigate the symptoms.
• Over half have self-diagnosed using the internet in order to help improve their pain.
• 96 per cent have been managing the pain with drugs for more than six weeks; almost three quarters (71 per cent) for more than three months; and more than a third (36 per cent) for over five years.
• Only 14% of people with back pain in the South West were referred by their GPs to exercise, the second lowest referral rate in the UK.

Back pain is the UK’s leading cause of long term sickness, responsible for more than 15 million sick days in 2013. One in seven (15 per cent) questioned with lower back pain said they are on long term sickness benefit or cannot work due to their symptoms, while 29 per cent have taken at least a month off in the past 12 months, the highest percentage in the country.  Over a third (36 per cent) of people say that the lack of diagnosis or knowledge is causing depression, while one in ten (9 per cent) are anxious they are suffering a more serious health condition. 

Consultant Orthopaedic Spinal Surgeon at Nuffield Health Plymouth Hospital, Mr Himanshu Sharma, said:  “There is a tendency to group every patient together in one category with lower back pain as ‘non-specific back pain’ if conditions like nerve compression, cancer and infection is not suspected at primary care setting. 

"Back pain is a symptom and the correct management could be offered better if a correct diagnosis is made at the first instance.

"Confusing central commissioning guidance and lack of robust and rational back pain management pathways often means GPs are reluctant to make referrals to specialists, or to send patients for scans to obtain a diagnosis at an earlier stage.

"This leads to huge numbers of people left without any real knowledge about what their problem is and how they are supposed to deal with it. For most, early exercise, physiotherapy and pain management will usually help, but if symptoms persist for more than 2-3 months, then further investigation is warranted. 

"Patients with atypical sciatica (trapped nerves causing back pain, buttock pain and proximal limb pain) are often undiagnosed for long. By avoiding out early scanning, there is also the danger that a very small number of patients with serious conditions will be missed, and this can also lead to extreme anxiety for some people.’’

The research also shows that patients in the South West are more than twice as likely to be guided towards painkillers (44 per cent) than to exercise (14 per cent), despite exercise being considered a vital part of recovery and treatment for many patients with lower back pain.  

This referral rate to exercise is the lowest in the country. Conversely, almost half (45 per cent) of pain sufferers said they are fearful of doing any kind of physical activity or exercise.   

Nuffield Health doctors say that for the vast majority of patients, early pain management combined with exercise or physiotherapy could be vital in preventing long-term problems.    

The lifestyle choices of people in the South West also appear to be exacerbating lower back pain prevalence.    Although one in five people in the South West suffer pain, two thirds (65 per cent) regard exercise as an important part of keeping fit and healthy, while 71 per cent say they lead a completely sedentary life - mostly sitting, reading, playing video games, watching TV or using a computer for most of the day, with little or no vigorous exercise, including walking.  

The figures show that people who lead sedentary lifestyles are more than twice as likely to suffer back pain (22 per cent compared with 47 per cent); once they have pain, nearly three quarters resign themselves to a sedentary lifestyle.

Consultant Spinal Surgeon at Nuffield Health Plymouth Hospital, Mr Himanshu Sharma, continued:  “Although millions of people suffer from debilitating lower back pain, there is still a lack of understanding about how to prevent and treat it. 

"We do know that delaying a diagnosis can be harmful due to the long-term impact it can have family life, careers and psychological welfare.  

"There may not be a medical or surgical solution for many, and doctors need to be honest about what can be achieved, but if a patient is empowered with knowledge then they can use the information to help themselves.  

"An early diagnosis can help prevent people from spending years in pain, reliant on potentially addictive pain killing drugs and resigned to an inactive lifestyle."

Nuffield Health Doctors are also urging patients to help themselves, given the findings of the research. 

1. Build regular exercise into your daily routine:  ‘Couch potatoes’ – Britons who lead a sedentary lifestyle - primarily watching TV or playing video games, with little or no exercise - are more than twice as likely to suffer back pain (22 per cent compared with 47 per cent);  while 74% of back pain sufferers lead sedentary lifestyles once they have pain. Those who don’t exercise tend to suffer more from severe back pain (56 per cent) than those who do and have always done so (44 per cent).
2. Make sure you are taking regular breaks at work: 31 per cent of the back pain sufferers in the South West do not take regular short breaks at work.   Three quarters (75 per cent) of the people surveyed said that their workplace doesn’t provide any kind of support or advice to help them with their problem.  In fact, employers are legally obliged to minimise the risk of employees developing back pain or making existing back pain worse. Talking to managers about how they can help you, through risk assessment and making changes where needed can be beneficial.
3. Pay attention in high risk jobs:  Over three quarters (77 per cent) who drive long distances for work suffer back pain – the highest in the UK – while 56 per cent of manual labourers and almost four out of ten (38 per cent) with desk jobs have lower back pain.   

Liz Adair, Director of Physiotherapy at Nuffield Health, said:  “Back pain is often a combination of factors, which can include poor posture, weak spinal supporting muscles and poor movement patterns.  

"Many people just need the right advice on what to do to help their back, while others could benefit from hands-on treatment. The important thing is to seek expert advice quickly, as research shows that early intervention is the key to getting rid of back pain quickly.”

For further information please contact Stina Sanders on 020 7010 0876 or Stina.Sanders@kindredagency.com