DxD Session held on 20 August 2018.
Dr Dinesh Sirisena graduated from Bart’s and The London Medical School in 2004 and completed specialist training with the London Deanery to become a Consultant in Sports and Exercise Medicine in 2014. Hs is now a Consultant in Sports Medicine at Khoo Teck Puat Hospital. He has specialist interests in shoulder, back and hip conditions, concussion management, medical education and ultrasound guided intervention to minimise surgical intervention.
Dr Dinesh Sirisena has worked across a range of sports, which includes professional football, premiership rugby, British Gymnastics, Mixed Martial Arts, Wimbledon Tennis, British Athletics and the London Olympic and Paralympic Games. His most recent experience as a team doctor was with Team Singapore at the 2017 SEA Games.
Dr Dinesh answered questions from readers on:
- Causes of back pain
- When is back pain a cause for concern
- Where to seek help for back pain in Singapore
- Treatment options for back pain
- Cost of back surgery
- Risk and complications of a back surgery
I am sorry to hear about your back pain symptoms - there can be many causes for pain in the back, but by far the most common is probably posture and conditioning. If you, like most of us, spend long hours in front of the computer at work or at home, and then perhaps use your smartphone on the MRT or your tablet in bed, its these things which as likely to be the main culprits for your back pain. The posture we adopt while using these items can lead to weakness in the back muscles, tightness in the fascia and all can generate pain. One can also develop degenerative changes along the way.
The easiest thing to manage this is to look at your activities and see if there are any changes that you can make. This might be better positioning of your devices, regular stretching and perhaps taking up some exercise. There are, of course, other reasons for pain, such as joint, disc or nerve issues in the back, but there are often other symptoms to go with it.
Sciatica is classically described as shooting pain that travels from the buttock down to the leg and can be associated with altered sensation or strength in the leg depending on the underlying cause. The reason this develops is because the sciatic nerve is irritated somewhere along its pathway and hence you experience either pain or sensory changes. The commonest reason for sciatica is due to irritation from the spine, either from a bulging or prolapsed disc, or from nerve root irritation from facet joint swelling. This then causes the pain.
Other causes I have seen in clinic are from irritation of the sciatic nerve at the level of the piriformis, otherwise known as piriformis syndrome, and following a hamstring injury in a footballer. In this case, it was due to the swelling around the nerve from the torn muscle and hence the sciatica symptoms.
Thank you for your question! Painkillers are very useful in the management of acute back pain that is limiting function and your ability to take part in normal day-to-day activities, but as the name implies, all that you are doing is settling the symptoms. The World Health Organisation has a “pain ladder”, with medicines that get stronger as you progress up it. It starts with simple medications such as paracetamol or anarex, before moving onto anti-inflammatories, and then the opiate-based medications.
In general, for acute pain, I tend to go high and then come down as soon as pain is settled, whereas for chronic pain, I suggest the opposite technique and use the weakest possible to control your symptoms.
If your pain is due to bones, paracetamol is a very good starting point, whereas if you have muscle spasm or inflammatory changes, anti-inflammatories are good. Used in combination, these can help with (neuropathic) nerve-type pain, but those that are more specific to neuropathic pain are usually prescribed by a physician. These include pregabalin, gabapentin and amitryptilline. These modulate nerve transmission to dampen down pain responses and hence alleviate your symptoms.
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