Are you female and pregnant?

Did the pain come on suddenly after an extended stay in bed or confinement to a wheelchair, or are you over 60?

Consult your doctor if you are unable to make a diagnosis from this chart and your back pain is severe or if the nature of long-standing back pain suddenly changes.

Go to chart MM Back pain in pregnancy (p.284)

possible cause You may have ankylosing spondylitis (inflammation of the joints between the vertebrae, resulting in the spinal column gradually becoming hard and inflexible). This is especially likely if you are between 20 and 40. Consult your doctor.

action Your doctor will examine you and arrange for you to have a blood test and X-rays (p.39) of your back and pelvic areas. If you are found to have ankylosing spondylitis, you will probably be given nonsteroidal antiinflammatory drugs. You will also be referred to a physiotherapist, who will teach you exercises to help keep your back mobile. These mobility exercises are an essential part of the treatment for this disorder and can be supplemented by other physical activities, such as swimming.

see your doctor within 24 hours possible cause You may have a crush fracture of a vertebra as a result of osteoporosis, in which bones throughout the body become thin and weak. Osteoporosis is symptomless unless a fracture occurs. The disorder is most common in women who have passed the menopause. However, a prolonged period of immobility will also lead to the development of osteoporosis.

action Initial treatment for the pain is with painkillers. Your doctor may also request bone densitometry (below). Specific treatment for osteoporosis depends on the underlying cause. However, in all cases, it is important that you try to remain active and take weight-bearing exercise, such as walking.

Bone densitometry self-help Relieving back pain

Most back pain is the result of minor sprains or strains and can usually be helped by simple measures. Try the following:

• If possible, keep moving and carry out your normal daily activities.

• Rest in bed if the pain is severe, but do not stay in bed for more than 2 days.

• Take over-the-counter nonsteroidal antiinflammatory drugs.

• Place a heating pad or wrapped hot-water bottle against the painful area.

• If heat does not provide relief, try using an ice pack (or a wrapped pack of frozen peas); place it over the painful area for

15 minutes every 2-3 hours. If your backache is severe or is no better within 2 days, consult your doctor.

Once your back pain has cleared up, you should take steps to prevent a recurrence by following the self-help advice for taking care of your back (opposite).

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