Back pain

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Back Pain Solutions

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Living with persistent pain

Pain is our built-in alarm system. It makes us aware that something might be going wrong in our body.
Pain is essential for our survival as it to protect our body. For example, if you put your hand too close to a hot stove, you feel the sensation of heat.

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We have danger detectors – called nociceptors – spread throughout most of our body. Pain is usually triggered when the brain receives messages from these nociceptors when they detect something potentially harmful. This message is sent to the brain as a signal that there may be danger. The brain then evaluates this message and decides whether the body needs protecting by producing pain. This is a normal reaction that protects us from any further harm.

Acute and persistent pain

Pain may be described as acute or persistent.

Acute pain usually begins quickly and lasts for a short period of time. It is the pain associated with things like a stubbed toe, a broken bone, a burn or having a tooth removed. Acute pain usually goes away after the underlying problem – the inflammation, injury or infection – has been treated or has healed.

Persistent pain, sometimes called chronic pain, is pain that lasts for more than three months.

What causes persistent pain?

Persistent pain is very complex and may be caused by a number of factors. It may occur alongside conditions such as arthritis, diabetes or fibromyalgia. It may occur after an injury or trauma to the body has healed. And in some cases the cause is not known.

Persistent pain is associated with changes to the nervous system (the nerves, spinal cord and brain). Throughout our lives our nervous system changes and adapts to help us learn from and deal with different experiences. This is called neuroplasticity. However, sometimes this normal process of adapting and changing becomes abnormal. It is no longer helpful. Persistent pain is an example of this.

Some changes to the nervous system affect the way the brain understands the information it receives about pain, and things such as touch or movement. In such circumstances, everyday activities that should not cause pain may cause pain. Pain may be worsened by staying in one position for short periods. The affected area may be tender to light pressure, and at times to very light touch. Often this pain can spread to nearby areas or to the opposite part of the body. This is often referred to as ‘central sensitisation’.


Gout is a common form of arthritis characterised by repeated attacks of extreme joint pain, swelling and redness. While most other types of arthritis develop slowly, an attack of gout usually happens suddenly, often overnight. Gout may be experienced in the feet, ankles and knees, elbows, wrists and fingers.  .

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What causes gout?

Gout occurs when uric acid, a normal waste product, builds up in your bloodstream and forms urate crystals in a joint. Your body makes uric acid when it breaks down purines, a substance found in your body and in some foods. Uric acid normally dissolves in your blood, is processed by your kidneys and leaves your body in urine.

If your body makes too much uric acid, or your kidneys can’t clear enough of it out, it builds up in your blood. This is called hyperuricaemia.

Having hyperuricaemia doesn’t mean you’ll develop gout – in fact most people with hyperuricaemia don’t go on to develop gout. Because of this it’s thought that other factors such as your genes may be involved.

Similar attacks to gout can be caused by a condition called pseudogout (or acute calcium pyrophosphate arthritis). In this case, crystals of calcium (rather than urate) are deposited in joint cartilage and then shed into the joint space. This is likely to affect your knees and other joints more than the big toe and is most common in people with osteoarthritis.

What are the symptoms of gout?

Symptoms of a gout attack include:

  • intense joint pain
  • joint swelling
  • skin over the joint may look red and shiny
  • affected joint may be hot to touch
  • tophi (lumps of crystals that form under the skin) may occur in people who have repeated attacks.



Back pain

If you have back pain, you’re not alone. It’s a common problem experienced by many Australians. In fact 1 in 6 Australians reported back problems in 2014–15. That’s 3.7 million people. For most people back pain comes on quickly (acute back pain), but then improves or goes away within three to six weeks.

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However, it is common for it to come back, with some people going on to develop more persistent pain (that lasts for more than three months).Back pain can have a significant impact on all aspects of life including daily activities, family life, work, recreation and social activities. But there’s a lot you and your healthcare team can do to deal with back pain so you can get on with life.

How does my back work?

To understand your back pain, it’s helpful to know a little about how your back works.

Your back is a complex structure that provides support for your pelvis, legs, ribcage, arms and skull. The spine is made up of bones called vertebrae that are stacked together to form a loose ‘S’-shaped column.

Each vertebra is cushioned by spongy tissue called intervertebral discs. These discs act as shock absorbers and give your spine its flexibility. Vertebrae are joined by pairs of small joints known as ‘facet’ joints. A mesh of connective tissue called ligaments holds the spine together.

Complex layers of muscle provide structural support and allow you to move. Your spinal cord runs through the centre of the vertebral column and connects your brain to the rest of your body.

What causes back pain?

The causes of back pain are not fully understood. Most people with back pain don’t have any significant damage to their spine. The pain comes from the muscles, ligaments and joints.

Common causes of back pain include:

  • repetitive or heavy lifting (manual handling)
  • sudden awkward movement
  • not getting enough regular physical activity (being sedentary)
  • poor posture
  • being overweight or obese
  • stress – muscle tension.

Some health conditions are also linked to back pain, such as:

There are also a number of things that can make it more likely that the back pain will become persistent, such as:

  • already living with, or developing, negative beliefs about your chances of recovery
  • already living with, or developing, depression or anxiety
  • work-related issues.

In a very small number of people, back problems are caused by a serious condition such as cancer, inflammatory problems, infection, fracture or compression of the nerves in the spine. However this is rare, and your doctor will check for these causes.


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