Comprehensive Guide To Back Pain Treatment In Singapore

Back pain is a common health problem throughout the world. Back pain, particularly lower back pain, is the second-most common reason for doctors’ visits. More than that, lower back pain is the main cause of disability worldwide, rendering millions unable to work or enjoy normal activities. Most back pain is non-specific, meaning doctors can’t connect it to a specific cause. However, with effective back pain treatment, people can manage their pain so that it does not affect their activities. 

Back pain can happen at any age, but it gets more common as people age. Back pain treatment varies according to the cause and severity of the symptoms. In this article, we discuss the causes and symptoms of back pain and what your options for back pain treatment in Singapore are. 

Understanding the Anatomy of the Back

The spine is a structure made up of vertebrae (bones), disks, joints, ligaments, tendons, muscles, and nerves that keep the body upright. 

The spine has four sections: 

• Cervical – the vertebrae of the neck (C1 – C7)
• Thoracic – the vertebrae of the upper back (T1 – T12)
• Lumbar – the lower back (L1 – L5)
• Sacrum and coccyx (S1 – S5)

Pain can occur in any section, but neck and lower back pain are more common because these are the areas of the spine that can bend and move more. 

Every section of the back includes vertebrae, intervertebral discs, ligaments, tendons, facet joints, and muscles. Any of these structures can develop problems that cause back pain.

Different Kinds of Back Pain

Doctors categorise back pain according to duration, location, and cause. In terms of duration, back pain is categorised as acute, subacute, or chronic.

• Acute back pain happens suddenly and usually doesn’t last long, just a few days or weeks. Acute back pain is often caused by a definable event like muscle strain when doing something unusual.
• Subacute back pain can happen suddenly or gradually and lasts between 4 and 12 weeks.  The underlying cause is often muscle strain or soreness in the joints.
• Chronic back pain can develop gradually or suddenly and is long-lasting, persisting beyond three months. Degenerative conditions like arthritis can cause chronic back pain. 

Back pain is also categorised according to location. 

• Lower back pain is the result of issues with the lumbar spine. Lower back pain is the most common kind and can be caused by many issues, such as strains and sprains, spinal fractures, slipped disks, degenerative disk disease, and more.
• Upper back pain is not such a prevalent problem. It is often caused by poor posture, disk problems, arthritis, and fractures. 
• Middle back pain is painful discomfort in the thoracic spine where the T1 to T12 vertebrae are located. Pain in this area can have various causes, including poor posture, muscle sprain or strain, a fall, obesity, a herniated disk, and osteoarthritis, to mention a few.

Causes of Back Pain

Many problems can cause back pain, including mechanical or structural issues, inflammatory illnesses and medical conditions. Back pain may also be present without any specific noticeable cause.

Mechanical/Structural Problems

The bones, muscles, ligaments, and disks can irritate or injure the spinal nerves, causing back pain, such as when one or more of these structures press against a nerve. Examples include:

Herniated disc – when the soft inside of a disk pushes through the thick outer layer, pushing against spinal nerves.

Sprain – when the ligaments in the spine get injured. Sprains are common when someone picks up or carries a heavy load and doesn’t do it carefully.

Strain – when the muscles or tendons of the spine get injured.

Spondylolisthesis – when a disc slips out of place and touches the nerves in the spinal cord. 

Degenerative disc disease – when, in older people, the discs between the vertebrae start to deteriorate, as in osteoarthritis.

Spinal stenosis – when the spinal canal narrows, so there’s limited room for the spinal cord and nerves.

Vertebral fractures – when one or more bones in the spine break as a result of a trauma or weakening of the bones.

Scoliosis – when the spine curves sideways in an “S” or a “C” shape, causing muscle strain and nerve compression.

Myofascial pain – when the connective tissues that support the spine tighten due to muscle overuse, inactivity, poor posture, stress, or injury.

Inflammatory Conditions

Inflammatory back pain stems from inflammation in the spine. The following conditions are typically associated with inflammatory back pain.

Ankylosing spondylitis: Ankylosing spondylitis is an autoimmune disease that causes inflammation in joints of the spine. The condition can be mild or extremely painful and debilitating. It can cause the spine to become stiff. 

Arachnoiditis: Arachnoiditis is a rare spinal condition stemming from inflammation of the arachnoid. The arachnoid is one of the membranes that encases spinal cord nerves. The condition can cause extreme pain.

Discitis: In Discitis, the inflammation is in the spaces between vertebrae.

Sacroiliitis: This condition causes back pain stemming from inflammation in one or both of the sacroiliac joints in the lower spine.

Other Medical Conditions

Many conditions can result in back pain as a symptom, including:

• Osteoporosis – weakening of the vertebrae that causes them to fracture easily.
• Fibromyalgia – widespread muscle pain throughout the body.
• Pain resulting from failed back surgery.
• Gallbladder inflammation.
• Kidney stones or infections.
• Tumours.
• Liver issues.
• Endometriosis, when uterine tissue grows outside the uterus.

How is Back Pain Diagnosed?

The first three steps in determining the cause of back pain are a thorough physical exam, obtaining a detailed medical history, and evaluating the patient’s symptoms. The outcome of this medical exploration will determine the tests necessary to confirm the diagnosis. 

Diagnostic imaging tests and blood tests help specialists to diagnose the cause of back pain accurately.

Diagnostic Imaging Tests

• X-rays help medical professionals to see bones and joints, enabling them to identify broken bones, abnormal bone tissues, or bone spurs.
• CAT scans (computerized axial tomography) use advanced X-ray technology to produce detailed cross-sectional views of the spine. CT scans deliver detailed imaging of fractures, bone malformations, vertebral slippage, bone spurs and conditions like spinal stenosis (narrowing of the spinal canal)
• MRI (magnetic resonance imaging) – produces detailed images of the body part under investigation, such as the spine. Created by radio waves and a strong magnet, these images help doctors diagnose issues with the soft tissues of the spine, including the discs, ligaments, and inflammatory conditions.
• Electromyography (EMG) measures the electrical activity in muscles and nerves. For instance, this test can reveal a herniated disc.
• Bone scans use a small amount of a radioactive tracer injected into a vein. When it reaches the bones, it measures bone metabolism and cellular activity, which helps specialists identify abnormal bone growth, infection, fractions that X-rays miss, and more.

Doctors also order various blood tests to determine possible medical causes of the back pain, such as an inflammatory disorder like ankylosing spondylitis.

Options For Back Pain Treatment

Often, back pain can resolve with rest and conservative approaches like anti-inflammatory pain relievers, injections, physical therapy, simple exercises, and massage.

Over-the-counter medications

Over-the-counter (OTC) pain relief medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can relieve the discomfort of a sore back. A hot compress or an ice pack is also useful to ease discomfort and reduce pain.

Physical Therapy 

Managing back pain does not mean bed rest. It’s essential to stay active. Regular exercises can strengthen the muscles around the spine, reducing pressure on bones and joints, and leading to less pain. Regular exercise also prevents stiffness, which is essential for continued movement. 

A qualified physical therapist who specialises in conditions that affect the spine can work out a simple home exercise program that a patient can follow at home without supervision. Keeping active can help individuals manage their back pain more effectively.

Prescription Medication

In some cases, back pain may be so severe that only prescription NSAIDs, like codeine, or hydrocodone can provide pain relief. These narcotics can only be used for a limited time under strict medical guidance,

Injections

Back pain caused by inflammation or damage to a nerve is often severe. In these cases, doctors may choose injection therapy to help relieve pain. There are many procedures for this purpose, but the following four are most often used.

1. Trigger point injections are used for pain associated with muscle spasms.
2. Joint injections relieve soreness between joints.
3. Facet joint injections treat inflammation of the facet joints that connect the spinal vertebrae.
4. Epidural steroids are used to relieve pain caused by inflamed nerve roots within the spinal cord.

Spinal Traction

Spinal traction is a non-invasive treatment that relieves pressure on the vertebrae, easing pain. It can be done manually or through a mechanical apparatus. It straightens the spine and stretches it, relieving compression of the discs.

Conditions that improve with spinal traction include slipped discs, herniated discs, degenerative disc disease, bone spurs, facet disease, and pinched nerves.

Surgical Back Pain Treatment

For back pain that doesn’t resolve with conservative treatments, several surgical options are available. The type of surgery depends on the cause being treated and the severity of the pain. All surgeries carry risks, and they don’t always take the pain away, so surgery tends to be the last option in medical efforts to relieve back pain.

Surgical procedures for back pain include: 

Discectomy and microdiscectomy

This surgery treats a herniated or bulging disc that is encroaching on a nerve by removing part of the disc. In microdiscectomy, the surgeon uses smaller incisions.

Laminectomy

This surgery treats spinal stenosis (narrowing of the spinal cord). The surgeon removes the bony spurs and the lamina (bone plates of the vertebrae) to make more room for the nerves in the spinal cord so they are not pressed together. 

Spinal fusion 

This procedure allows the surgeon to join two or more vertebrae to stabilise their position. The surgeon removes one or more discs and uses bone grafts or metal devices instead to stabilise the spine.

Foraminotomy 

With this surgery, the surgeon cleans the foramen (openings) where the nerve roots leave the spinal canal. The larger openings relieve pressure on the nerves.

Disc replacement

A disc made from synthetic materials is implanted to replace a damaged disc.

Radiofrequency lesioning 

Radiofrequency lesioning, or radiofrequency ablation (RFA), uses heat generated by radiofrequency energy to target specific nerve fibres and stop them from sending pain signals. The procedure effectively stops pain, but when the nerves grow back, the pain might return.

Spinal cord stimulation

A medical device is implanted in the body to stimulate the spinal cord with electricity. This procedure treats severe pain that doesn’t respond to other treatments. The electricity blocks pain signals between the spinal cord and the brain.

Surgery to relieve back pain is only considered when other treatments have failed. How long it takes to recover depends on the condition being treated, the type of surgery, and the individual’s general health. 

Alternative Therapies For Back Pain Treatment

Alternative therapies are usually combined with conventional therapies. We highlight a few here that doctors may recommend for back pain treatment.

Massage

Massage therapy can be beneficial for lower back pain, which is the most common form of back pain. The modality uses techniques like kneading, stretching, and compression to reduce muscle stiffness, improve flexibility, alleviate swelling, and boost blood flow. 

Massage has the added psychological benefit of helping patients to relax. The release of tension also helps to ease the pain.

Chiropractic

Chiropractors are experts in the functioning of the nervous system and the spine. They specialise in spinal manipulation, which has been proven to be an effective treatment for back pain.  Chiropractic is a conservative treatment that restores function and helps to resolve back pain.

Acupuncture

Acupuncture originated in China and forms part of traditional Chinese medicine. During an acupuncture treatment, a qualified practitioner inserts fine needles into energy points in the body, which can cause the body to release various neurotransmitters, including endorphins. Endorphins are the body’s own pain-relieving chemicals. Acupuncture treatment can produce instant relief from pain, lasting a few days or weeks.

Yoga

Yoga is an age-old practice involving many poses or postures and breathing exercises. When done correctly, yoga helps develop and maintain muscle strength, and promotes flexibility. Practised regularly, it improves balance and bone strength. It also helps to reduce back pain. It’s a gentle modality suitable for older people.

Transcutaneous electrical nerve stimulation (TENS)

This pain therapy uses a so-called TENS machine to deliver low-voltage electric pulses to the skin to relieve pain. Many people use it for back pain, joint pain, arthritis, and nerve pain.

It is believed that TENS stimulates the production of endorphins that help with pain relief. Research has shown that some people benefit from it and others do not. The treatment should be delivered by a healthcare professional.

Risk Factors for Back Pain

Back pain is common. Virtually every person experiences back pain at some stage in their life. Some lifestyle habits that contribute to this eventuality are often avoidable, such as those mentioned below.  

Lack of Exercise

Back pain is prevalent among people who lead a sedentary life. Sitting for most of the day weakens back and stomach muscles. Weak muscles can support the spine effectively, increasing the likelihood of back pain

Overweight or Obesity

Overweight and obesity are significant risk factors for back pain due to the extra strain on the spine, muscles, and joints. Extra weight increases pressure on the knee joints and the lower back. Over time, the pressure on the spine can lead to degenerative disc disease, causing them to herniate. Obesity also increases inflammation, which is linked to chronic pain. Read more about knee pain treatment here.

Job-Related Risk Factors

Where and what you do at work can contribute to back pain. Office jobs that require long hours in front of a computer can lead to back pain, especially if you don’t keep a good posture or your workstation is not ergonomically sound.

On the other hand, jobs that involve standing for long periods, require heavy lifting or involve repetitive movements can cause back injuries and undue strain leading to chronic back pain.

High Stress Levels

Doctors have noticed that extreme stress puts their patients at greater risk for low back pain. Psychological factors like anxiety and depression make people more prone to back pain, partially because muscles tend to tense up when a person is tense. Tense muscles can contribute to back pain.

Smoking

Back pain is common among smokers. Smoking damages arteries, including the arteries in the discs and joints of the back, which may be a contributing factor to back pain. Added to that, smoking is a risk factor for osteoporosis, which leads to thinning of bones, making them vulnerable to fractures.

Lifestyle Habits to Protect Your Back and Relieve Back Pain Without Surgery

Back pain can be debilitating taking the pleasure out of life. It is worthwhile to live in a way that boosts your health and lowers your chance of developing chronic or long-lasting back pain. 

Follow an anti-inflammatory diet

An anti-inflammatory diet can prevent inflammation in the body, including inflammation that causes back pain. Foods that protect against inflammation include:

• Leafy greens
• Fruits and berries
• Monounsaturated fats derived from avocado, olive oil
• Omega-3 fats derived from fatty fish, such as salmon, sardines, and mackerel
• Nuts and seeds
• Legumes
• Whole grains
• Dairy, and eggs

As far as possible, avoid processed foods like baked goods, crisps, condiments, and so forth, as they contain high levels of saturated fat and refined carbohydrates that contribute to weight gain and inflammation.

Maintain a Healthy Weight

As mentioned earlier, extra weight puts strain on the spine and back muscles. By not allowing yourself to carry unnecessary weight, you can prevent back pain as well as a host of other health issues like heart disease, diabetes, and hypertension, among others.

Avoid High Heels 

Don’t wear high heels or only wear them occasionally for short periods. High heels and platform shoes affect the alignment of the spine, lower back, and hips, which strain the back muscles, leading to back pain, if not now, then later in life.

Avoid a Sedentary Lifestyle

An inactive lifestyle holds many health risks. Slouching in front of the TV or sitting in front of a computer for hours on end and not getting any exercise leads to weak muscles, overweight and general poor health.

If you are not sporty and hate exercise, try going for regular walks or swimming. Think of the health benefits you gain:

• Little or no pain, including back pain
• Less inflammation 
• A trim body
• A healthy immune system
• Strong bones and muscles

Don’t Smoke

Smoking contributes to back ache through its effect on blood flow. Smoking constricts blood vessels, leading to poor blood flow depriving tissue throughout the body of adequate oxygen and nutrients. Lack of nutrients and oxygen in the spine can weaken its structures, leading to chronic back pain.

Back Pain Treatment in Singapore

If you are looking for back pain treatment in Singapore, you will find a number of non-invasive and invasive treatment modalities. Diagnosing the cause of back pain can help determine which path to follow in the treatment journey. Ray of Health and RadLink are two of Singapore’s premium healthcare services provided that can help you start your journey towards effective pain management.

Ray of Health

A premium healthcare platform in Singapore, Ray of Health focuses on musculoskeletal health, offering insights and treatments for various conditions. Led by Dr. James Tan, an experienced orthopaedic surgeon in Singapore, the platform provides information on:

• Orthopaedic Treatments: Addressing orthopaedic issues related to the upper limbs, spine, and lower limbs.
• Sports Injuries: Guidance on prevention and treatment of common sports-related injuries.
• Specific Conditions: Information on effectively managing back pain, shoulder dislocation, meniscus tears, ACL tears, and more.

Ray of Health emphasises personalised care, aiming to help individuals lead comfortable and active lives through customised treatments.

RadLink

RadLink is a leading provider of comprehensive diagnostic imaging services in Singapore. Their services include:

• Diagnostic Imaging: RadLink offers premium diagnostic services such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasound, Mammography, and Bone Mineral Densitometry (BMD).
• Nuclear Medicine: Advanced imaging techniques for diagnosing and treating various conditions.
• Needle Biopsy: Procedures like breast biopsies and MRI-US-guided prostate fusion biopsies.
• Teleradiology: Remote radiology services facilitating timely consultations and diagnoses.
• Radiopharmaceuticals: Production and supply of radiopharmaceuticals for medical imaging.

RadLink operates multiple centres across Singapore, including specialised facilities like RadLink Women Imaging and RadLink PET and Cardiac Imaging Centre. Their team comprises experienced radiologists dedicated to delivering accurate and efficient diagnostic services.

Final Thoughts

It is not always possible to avoid back pain. Back injuries can happen anytime and health conditions like arthritis or an autoimmune disease like ankylosing spondylitis are not in our hands. If you experience persistent backache, effective back pain treatments are available.