Keeping your back strong and supple is the best way to avoid getting back pain.

Regular exercise, maintaining good posture and lifting correctly will all help.

If you have recurring back pain, the following advice may be useful:

• Lose Weight – too much upper body weight can strain the lower back; you can use the healthy weight calculator to find out whether you need to lose weight
• Wear flat shoes with cushioned soles as they can help reduce the pressure on your back
• Avoid sudden movements which can cause muscle strain
• Try to reduce any stress, anxiety and tension
• stay active – regular exercise, such as walking and swimming, is an excellent way of preventing back pain (see below)

Exercise

Exercise is both an excellent way of preventing back pain and of reducing it, but should seek medical advice before starting an exercise programme if you've had back pain for six weeks or more.

Exercises such as walking or swimming strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt.

Activities such as yoga or pilates can improve the flexibility and the strength of your back muscles. It's important that you carry out these activities under the guidance of a properly qualified instructor.

Below are some simple exercises you can do several times a day at home to help prevent or relieve back pain.

• Bottom to heels stretch – kneel on all fours, with your knees under hips and hands under shoulders. Slowly take your bottom backwards, maintaining the natural curve in the spine. Hold the stretch for one deep breath and return to the starting position. Repeat eight to 10 times.
• Knee rolls – Lie on your back and place a small flat cushion or book under your head. Keep your knees bent and together, then roll them to one side while keeping both shoulders on the floor. Hold the stretch for one deep breath and return to the starting position. Repeat eight to 10 times, alternating sides.
• Back extensions – Lie on your stomach, and prop yourself on your elbows. Arch your back up by pushing down on your hands. Breathe and hold for five to 10 seconds. Return to the starting position. Repeat eight to 10 times.

Stop these exercises immediately if they make your pain worse.

Posture

How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture.

Standing

Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.

Sitting

Make sure you sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back. 

If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.

Driving

Make sure that your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Your foot controls should be squarely in front of your feet.

If you are driving long distances, take regular breaks so you can stretch your legs.

Sleeping

Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight.

If your mattress is too soft, place a firm board (ideally 2cm thick) on top of the base of your bed and under the mattress. Your head should be supported with a pillow, but make sure your neck is not forced up at a steep angle.

Lifting and carrying

One of the biggest causes of back injury, particularly at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain. You should:

• Think before you lift – can you manage the lift? Are there any handling aids you can use? Where is the load going?
• Start in a good position – your feet should be apart, with one leg slightly forward to maintain balance; when lifting, let your legs take the strain – bend your back, knees and hips slightly, but do not stoop or squat; tighten your stomach muscles to pull your pelvis in; do not straighten your legs before lifting as you may strain your back on the way up.
• Keep the load close to your waist – keep the load close to your body for as long as possible with the heaviest end nearest to you.
• Avoid twisting your back or leaning sideways,particularly when your back is bent – your shoulders should be level and facing in the same direction as your hips; turning by moving your feet is better than lifting and twisting at the same time.
• Keep your head up –once you have the load secure, look ahead, not down at the load.
• Know your limits – there is a big difference between what you can lift and what you can safely lift; if in doubt, get help.
• Push rather than pull – if you have to move a heavy object across the floor, it is better to push it rather than pull it.
• Distribute the weight evenly – if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.

If your child needs to carry a bag to school, they should use a well-designed backpack that is worn over both shoulders. Avoid putting anything unnecessary in their bag to keep the weight to a minimum.

New services to reduce your agony are cropping up. And they are a big business opportunity as well.

Specialist Solution

Experts say that in India, chronic pain affects 30 per cent of the adult population, particularly women and the elderly. About 20-25 per cent of them suffer from musculoskeletal disorders or MSD (which affect muscles, joints, tendons, ligaments and nerves) and joint disorders. Back pain accounts for another 25-30 per cent. Headache and migraine is the reason behind 5 per cent of cases of persistent pain, while another 2 per cent suffer from pain related to cancer.

“Of the 100-120 patients who visit each of my centres every month, the majority comes for treatment of backache and slipped discs, followed by neuropathic (nerve-related diseases or damage) issues and accident victims,” says Kothari, whose chain has six clinics in Mumbai, and one each in Goa and Mauritius.

Says Dr K.J. Choudhary, chairman of Samvedana Hospital and Pain Management Institute in New Delhi and senior anaesthesia consultant with the Apollo Group: “Of the 10-15 chronic patients I see every day, only 2-3 require surgery to control the pain.”

Apart from pain specialisation at leading hospitals, an estimated 30-40 standalone pain clinics have come up in India in recent years, including Pain Clinic of India, Delhi Pain Management Centre (promoted by G.P. Dureja, who set up a pain management clinic at the All India Institute of Medical Sciences, AIIMS, way back in 1986), Samvedana Hospital in Noida, Dardia Pain Clinic in Kolkata, among others. Mumbai alone is estimated to have 15 such clinics. And then there are the centres in tier-2 cities such as Dr Hitesh Patel’s Livewell, Giriraj Pain Management Centre and Pain Care Clinic in Ahmedabad. Experts say that most cities have at least 2-3 pain clinics.

ADVANTAGE:

Fortis Healthcare is implementing an interventional pain management programme in many of its hospitals (Biwash Banerjee)

TENDER CARE

Pain clinics specialize in more than a dozen methods of treatment:

• Epidural (spinal) injections: given under real-time X-rays using a fluoroscope
• Radio frequency ablation: a high-frequency alternating current is used to treat a medical disorder
• Microscopic discectomy: a surgery to cure pain due to slipped discs
• Ozone therapy: more oxygen is introduced in the body by injecting ozone; used in back pain management
• Sympathetic blocks: involves injecting numbing medicine around the nerves in the lower back or neck to get rid of pain temporarily
• Blocks for cervical pain: an injection to relieve neck, shoulder or arm pain
• Cancer pain management
• Diabetic neuropathic pain management: treating pain or loss of feeling in the toes, feet, legs, hands, and arms due to diabetes
• Advanced neuromodulation therapy: advanced medical device technologies to enhance or suppress activity of the nervous system for the treatment of a disease
• Ultrasound-guided nerve blocks
• Spinal cord stimulator: a device used to exert pulsed electrical signals to the spinal cord to control chronic pain.

A reason for the profusion could be the relatively low cost of setting up a pain clinic. “The investment in a pain clinic is about Rs 50 lakh (for a rented building in a tier-2 city) and breakeven can happen within a year,” says Kothari. Compared to this, a modern eye care clinic may require 2-3 times the investment, and a longer gestation period; a corporate hospital with 250 beds breaks even in 5-7 years.

When you are backed up against the pain you no longer have to put up with those pesky backaches as new and advanced interventional procedures offer a quick and easy alternative to surgery.

If there's one kind of ache that most of us are familiar with, it's a backache. It may originate in almost any part of the back and immobilise us. The worst part is that just when you think the pain has settled, it resurfaces, forcing those who stay on painkillers, do rounds of physiotherapists or keep switching doctors in search of relief. "Despite pain being the fifth vital sign, it is ignored by doctors until it shows on an MRI scan," says Dr K J Choudhury, senior consultant, pain management, Indraprastha Apollo Hospitals.

According to estimates, spinal pain, particularly lower back pain, affects about 40 to 80 per cent of the population in a lifetime. And, this is going to be worse with experts predicting that in the coming years 80 per cent of the population will have spinal or low back pain at some point or the other during their lifetime. "With younger and younger complaining of backache, we are witnessing a paradigm shift in the age group of people suffering from back pain," says Dr Ashok K Saxena, international pain specialist and editor of Indian Journal of Pain.According to experts, apart from poor dietary habits and high stress level, lack of physical activity and sitting in the same posture at a stretch are the main reasons why more and more people are getting a bad back pain.

CONSULT A PAIN SPECIALIST

CHRONIC pain is a disease in itself. The earlier this is treated, the better. According to experts in pain management, ninety percent of the people with back pain just require simple medication and treatment which doesn't cost much. But unfortunately one in five patients with chronic pain in India don't get the right treatment in time mainly because they continue to consult doctors who are unable to arrive at a diagnosis and cure quickly. "Often doctors tell their patients that their pain is in the mind when they are unable to find the source of pain through scans," says Dr P N Jain, President, Indian Society for the Study of Pain (ISSP).
According to Dr Jain, such people keep living in acute pain which later turn into chronic pain and require costly procedures. "It is important to move on from an orthopaedician to a pain specialist if the former is unable to pinpoint the source of pain," says Dr Saxena. Pain specialists deal in the management of pain that ranges from migraine to neck pain to cancer pain. According to experts, the approach of a pain specialist in finding a cure for back pain differs from that of an orthopaedician's."Many orthopaedicians choose a conservative approach such as a surgery to cure your back pain conditions. Whereas pain specialists mainly deal in noninvasive management of pain," says Dr Kailash Kothari, spine and pain physician, Breach Candy Hospital, Mumbai.

Also, they have an edge over other specialists as their approach is holistic. They are trained in delivering pharmacological medication, precision diagnostic and interventional procedures which are required when conventional methods fail. For instance, studies suggest that more than half the patients who see a doctor for back pain undergo MRI scans. And even though all of them had healthy backs, two out of three of them came back with M.R.I. reports that showed disk problems. In such cases while an orthopaedician usually suggests surgery by trusting the imaging results, pain specialists apply other approaches to be sure about the source of pain generator. "Scans don't tell you the whole story, which is why we try to investigate the sources of pain generator which could be in the muscles or discs or facet joints or spinal canal stenosis through newer diagnostic techniques such as diagnostic injections or nerve block or provocative discography," says Dr Kothari.

TECHNIQUES TO CURE PAIN

There are no simple cures for backache, is what most people suffering from it think. Most of us put up with chronic back pain and keep suffering for years thinking that the damage to our spine is irreversible and we have to learn to live with it. What many of us might not know is the growing number of interventional procedures to treat all kinds of backache problems without a cut in the body. These are an alternative to surgeries, which most patients fear going for and cost a lot. "Ninety per cent of painrelated surgery can be avoided by doing interventional procedures which assure high success rate, have low morbidity, cost less and doesn't require hospitalisation.

Moreover these procedures can be repeated without any morbidity," says Dr Neeraj Jain, senior consultant, pain management, Spine Disc and Pain Clinic. For the first time in India, a set of guidelines on back pain diagnosis and treatment are released by an association of pain specialists. Formulated by ISSP in collaboration with the Brufen Foundation, the protocol and guidelines are formulated to help doctors in providing a welldefined sequence of diagnostic investigations and the line of treatment for specific conditions associated with acute or chronic pain. The guidelines also include a list of advanced interventional procedures which could be done in treating various back ache problems. Here we inform you about a few of them which have helped many in getting rid of their pain.

Vertebroplasty

Had you been taken to the doctor for a verterbral collapse some years back, you would have taken weeks to recuperate from a major surgery. Today, an expert in interventional procedures takes less than half an hour to fix your broken spine bone. A patient with verterbral collapse, either due to an injury or osteoporosis or bone metastatis, are nowadays treated with vertebroplasty, a non-invasive, quick fix procedure done under local anaesthesia. The doctor first identifies the affected vertebra and subsequently injects a special type of liquid cement material into the centre of the vertebral body. Once set, the cement gives the vertebra extra strength, and gives immediate relief from the pain. The patient is discharged the same evening and is able to walk the next day. "It's an excellent procedure with very low incidence of side effects and morbidities in patients," says Dr Neeraj Jain.

RECOMMENDED FOR:

Osteoporotic fractures, vertebral haemangiomas, painful spine bones after spread of cancer, non cancerous painful tumours of spine bones and to augment strength of weak spine bone for other surgical procedures.

Intradiscal Electrothermal Therapy (IDET)

If you have been suffering from low back disc pain for more than six months without any relief from exercises, medication and corticosteroid injections, it's time to talk to your doctor about IDET.
IDET is a technique to treat discogenic back pain. It uses a probe inserted into the disc to heat the tissues within the affected disc. Heating the inside of the disc causes the tissues to shrink. It also burns the small nerve fibres in the periphery of the disc. To put it simply it reduces the volume of disc by burning the tissues. "This procedure is developed for the treatment of chronic lower back pain originating in discs," says Dr Choudhury.
IDET is a safe procedure with fewer complications arising in not more than 20 per cent of people going for it. But the most important aspect of this procedure is choosing the right patient.
Patients must fit into the criteria and should show lack of satisfactory improvements with intensive exercise, oral anti-inflammatory medication and physiotherapy. Also, people with weak spine or inflammatory arthritis and people with advanced stages of disc failures are not recommended to go for this procedure.

RECOMMENDED FOR:

For patients with symptoms from one or more discs, with tears or fissures in which the nucleus is contained and where a disc is bulging but has not ruptured.

Spinal Cord Stimulation

SPINAL cord stimulation offers hope for those patients who have not experienced success with conventional therapies for spinal pain relief. It's an advanced as well as expensive procedure where a small pulse generator is implanted in the back which sends low-level electrical signal to the spinal cord or to specific nerves to block pain signals from reaching the brain. The procedure is usually done using a local anaesthetic and a sedative. "In simple words it is a pacemaker implantation for spinal cord conditions," says Dr Choudhury.

Only selected patients qualify for this procedure, who have had a successful trial period with the spinal cord stimulator, which takes about 50,000. So, you don't have to take a risk of spending huge money on this procedure which might not show good results for your condition. "It's a very common procedure in western countries but here I do about 5 to 6 procedures in a year. And, my patients haven't come to me for complications yet," says Dr Choudhury. On an average, a person doesn't need the stimulator more than an hour a day.Earlier the stimulator came with a battery life of 2 to 5 years but nowadays they also come with rechargeable batteries.

RECOMMENDED FOR:

Spinal cord stimulation is recommended when conservative methods fail to relieve pain. However, in certain conditions it is an ideal treatment: people with failed back or neck surgery syndrome, pain owing to peripheral vascular disease and those in ischaemic pain.