Chronic back pain is on the rise – in part because the way we treat it often does more harm than good. It’s time to think differently about our aches.  One in four adults are experiencing it right now, and 90 per cent of people having back pain at least once in their life. Nearly a quarter of all primary care appointments for adults are for back pain.Back pain is a leading cause of disability around the world. In the US alone it costs an eye-watering $635 billion a year in medical bills and loss of productivity.

Much of the blame has fallen on our increasingly desk-bound lifestyles and growing lifespans, which mean more years of wear and tear on our spines.   Slumping in front of computer screens puts pressure on the muscles, ligaments and discs that support the spine and can deactivate muscles that promote good posture.   Obesity (amplifies the mechanical strain on the back and decreases mobility, and increases the production of inflammatory chemicals associated with pain.) and smoking (associated with a clogging of the arteries, which can damage the blood vessels that supply the spine) , are both huge contributors to back pain.

Identifying which of these problems has led to your own back pain is incredibly difficult. According to one study in the US, Less than 1 per cent of people who seek help will have something seriously wrong,  It turns out that MRI scans simply cannot indicate to a doctor what is wrong. They are not only be a waste of time and money, but it can actually worsen your back pain. Once you start to look for abnormalities, you will find them. Once that happens, doctors are more likely to prescribe painkillers, steroid injections or surgery, which may be unnecessary, ineffective and sometimes harmful.  In fact, people  who have had an MRI are more likely to move on to surgery, exposing them to the risk of infection and other complications. “The potential for harm has been shown in many studies,” says Buchbinder.

In the UK, for instance, patients are offered anti-inflammatory steroid injections, but these have been shown to be no more effective than placebo. They can also cause increased appetite, mood changes and difficulty sleeping.  In the US doctors tend to prescribe stronger opioid painkillers than are necessary,  fuelling the opioid crisis that has decreased life expectancy in the US. Backache is the number one reason for prescribing opioids. (Part of an unusually long article. Helen Thomson in New Scientist)

Tomorrow: The probable causes of back pain and what to do about it