Many cases of back pain seen in the Emergency Department (ED) have varying diagnosis yet many require prompt symptom management rather than an appointment with a specialist. Therefore, back pain is introduced as a condition in GPNext for primary care to manage, relieve and monitor symptoms.
By Adj Asst Prof Jacob Oh
Head of Spine Service, Consultant & Deputy Head
Department of Orthopaedic Surgery, Tan Tock Seng Hospital
How Common Are Lower Back Pains?
Back pains are a common health problem in our community and a leading cause of disability affecting people of all ages. The 2010 global burden of disease study estimates that lower back pain is among the top 10 diseases and injuries accounting for the highest number of diseases-adjusted-life-years (DALYs) worldwide. 80% of individuals will experience low back pain at least once in their lifetime!
The types of back pain we see in the hospital environment vary widely. Depending on age group, younger sufferers of back pain tend to present with more acute symptoms with preceding trauma, while for elderly patients it is a more chronic indolent process.
What Can We Do for Back Pain Within Our Community?
A simple x-ray can be very valuable in your diagnosis. Degenerative changes such as lumbar spondylosis, spondylolisthesis or degenerative scoliosis are very common and may be managed in the community.
X-Ray showing lumbar spondylosis
Examples of such strategies include:
- Analgesia – Typical analgesia includes the use of paracetamol, nonsteroidal anti-inflammatory drugs (NSAID) or opioids such as tramadol. Consider starting Gabapentin or Lyrica if the patient complains of persistent radicular pain or neurogenic claudication.
- Physiotherapy – Start off with simple stretching exercises (hamstrings, piriformis, psoas stretches) and gradually progress to core and hip abductor strengthening exercises. Swimming, walking and cycling are generally safe and do not cause too much impact on the spine.
When to Refer to a Specialist?
A patient with persistent lower back pain should be screened for red flags (weight loss/loss of appetite/ severe night pain/bladder or bowel incontinence). Also, patients with disabling pain or neurological deficits should be referred for further assessment.
What Can We Offer?
Spine surgery performed at TTSH
At TTSH, the majority of back-pain related cases are managed conservatively and the treatment is no different from that in the community. For more complex cases, we work closely with our physiotherapists, pain specialists, radiologists and spine specialists to help patients refractory to first line treatment get better.
While there is a lot of stigma in the community regarding spine surgery, latest advances in spine surgery have significantly reduced patient morbidity and hastened recovery time. Such advances include intraoperative computed tomography (CT) 3D navigated imaging of the spine, nerve root neuro-monitoring and minimally invasive approaches.
With a strong primary care team and a tertiary multidisciplinary team standing back to back, we hope to deliver comprehensive patient support for back pain, and improve the overall spine health within our community!