In this article, I will write general things about back pain. This article will be followed by the causes, treatment and overall management of back pain. Back pain involves the whole spine from neck to the bottom of the spine.
Back pain is a common medical problem. In the U.K, over 80% of pain clinic visits are for back pain. 80% of people during their life time will suffer at least one episode of back pain. The work loss and the effect on the economy due to back pain is huge in the UK. Five million work days are lost per year due to time taken off owing to back pain. The Government spends around 800 million sterling a year to treat back pain.
In Sri Lanka, the back pain sufferers as an overall percentage is less than in the UK. May be around 50% visits to the pain clinic in Sri Lanka.
Vast number of patients come with joint pain as well. Spinal issues are less amongst the Asians compared to the Caucasians. Caucasian bones are brittle compared to our part of the world. May be Vitamin D and sunlight plays apart.
But still it’s a common medical problem in Sri Lanka. Back pain sufferers seek help from Manthra Karayas, Kattandiyas and health professionals which includes Eastern (Ayurvedic physicians) and Western medical professionals. Even though I am not a fan of eastern medicine, there are many people who believe in endogenous medicine. We need to respect their views. As medical professionals, our aim should be not to do any harm to the patient in the first place. While keeping this in mind, we should try and help the patient with his pain and do our best to alleviate it. We should also ask ourselves whether we would carry out the same procedure on our mother, father or brother. Then treating patients becomes straight forward and easy. For example, my father came down to Colombo on three occasions to have procedures carried out by me on his back. Even though I should not have done under the UK GMC guidelines, I had no other option in Sri Lanka as there was no trained pain consultants at the time that I can trust for my father to have the procedure. On the first occasion, I recommended the procedure and on the subsequent two occasions, he requested me to repeat the procedure. All went well.
I find it challenging to treat Sri Lankan patients compared to the English patients. As a nation as a whole, we are poor listeners and our patients find it difficult to follow advice and instructions. My consultations in England are shorter than in Sri Lanka. This is mainly due to communication skills of the English patients.
I will give two scenarios which took place recently.
I had a 37-year old executive as a patient this week. He has seen 4-5 doctors ranging from rheumatologist to neuro surgeons. According to him, no diagnosis was given and therapies had not worked. The diagnosis was not rocket science. It was evident in the MRI scan of the neck. It is also my experience within the short time in Sri Lanka that no patient comes to me and praises the previous doctor. Most are critical about the previous consultant. I am no exception to them when they go and see the next consultant. This quality is inherent in us.
They do the travels until they hear what they want to hear from a consultant medic, ie “You will be fine. Don’t worry”. So, they go from one consultant to another. This gentleman came with neck pain and pain in the upper back. MRI scan and the X-rays showed a severe cervical spondylosis with facet joint degeneration. One of the worst scans I have seen in the neck for someone in his age group. I discussed in detail for 20-30 minutes the options available and offered the most suitable procedure. Went out of my way to get a PCR organised urgently. While going for the PCR, he asked me to cancel the procedure as the mother and family was not happy. A group of non-medics have made a decision regarding the treatment for this gentleman. The mother was not there in the consultation.
In England, it will be the mother who will calm down the son and encourage him to have the procedure. In this case, money was not an issue as the patient was insured. When patients see consultants, it is best to follow medical advice. Doctors cannot enforce treatment on patients as the consent is needed. I feel sorry for this gentleman as I could have easily helped relieve his pain.
While writing this article, I had another patient’s mother ringing me and trying to discuss the patient who is her daughter 24 hours prior to the procedure when everything was discussed with the patient in clinic for 30 minutes. In England, we do not discuss with the family without the consent of the patient. No family member can pick the phone up and call the doctor for medical advice for another member of the family. I politely explained to the mother that I cannot discuss the daughter’s condition with her. Father is the one who accompanied the daughter for the consultation.
In the previous article, I discussed the medical ethics for doctors. I am confused as to how to educate our public regarding health norms and communications.
Next week, I will discuss the lower back pain causes in detail. Back pain is due to
1. Muscular pains
2. Pain due to ligamental damage
3. Pain due to bones and disks
4. Facet joint pain - small joints
5. Sacroiliac Joint pain - Large joints
Dr Namal Senasinghe is a consultant in pain medicine who was based in England for 25 years. He has set up the ‘London Pain Management Centre’ at 31 Horton Place, Colombo 7, which was opened by Prime Minister Mahinda Rajapaksa in September 2020.
(To be continued next week)