“Help! I have excruciating back pain, it came from nowhere, what do I do!?”
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Patients often seek me out when they are in excruciating pain during an episode of non-traumatic acute severe low back pain (NTAS-LBP…for acronyms sake).
NTAS-LBP is when one gets excruciating (aka ‘severe’) low back pain suddenly (aka ‘acute’) “out of nowhere” whilst doing something completely normal (bending over, squatting down, standing up from sitting) (aka ‘non-traumatic’), it usually involves involuntary muscle spasms which are very painful and worrying as the patient can’t control them very well.
NTAS-LBP can occur in anyone, across all ages, whether they’ve had low back pain or not, but normally I see it clinically in 20–45 year olds.
Here’s what we do know:
1. It really sucks, initially
The first 24–48hrs could be the most excruciating and uncontrollable pain you’ve experienced in your life, however usually there’ll be a….
2. Position of comfort
It might be sitting leaning one way, or lying with your legs up, with slow planned movements try to find what is the most comfortable or least painful position and remember it but if you can’t find a position of comfort…..
3. Some patients need medications to help
If you can make it to a car and have someone take you to the nearest walk-in clinic, doctors there can prescribe you strong pain relief and muscle relaxants (if you are experiencing muscle spasms…but if you can’t make it to a Doctor and you are in dire need of assistance, don’t be afraid to….
4. Access ED/Ambulance services
Don’t be a hero, dial triple zero …. if you really need to…keeping in mind we’re currently in a pandemic with an overburdened healthcare system.
Especially seek emergency services if you have also lost bowel/bladder function or have pain or neural symptoms referring down both legs.
You may feel like you are desperate to try anything but please….
5. Do not to seek hands-on treatment in the first 48–72 hours
The risk vs the possible reward is not worth it, the chances of making you worse is a lot worse and our value is mainly in reassurance and saying all of this stuff anyway. But don’t be too concerned because…..
6. Most of the time there isn’t any serious injury
Remember, this pain came on with a low, possibly everyday load. The severe pain will usually settle over the first 2 days to a more mild-moderate pain and allow for a proper assessment towards the middle-end of the first week. After that time we can work out what is happening and if there’s any need to investigate further with diagnostic imaging, however in the majority of cases there isn’t a need for imaging as it won’t change management. However in a couple of weeks if there is ongoing issues we can then work out a plan.
When in doubt, contact your nearest Physiotherapist or GP Clinic and ask for assistance, perhaps there’ll be a Telehealth service you access to ask questions and get some advice.
For some fantastic information on Low Back Pain, select here.
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