My mum is seeking attention with back pain

Dear Prof,

My mum is 64. Every morning she complains of back and waist pain. She’s always expecting someone, especially dad, to help her out of bed. Could this be a sign of old age? I honestly don’t believe she’s too old to get out of bed by herself. Could she be seeking attention or something is truly wrong with her? Can you recommend some drugs to treat the pain?

Thanks.

Kelechi, Owerri

Dear Kelechi,

I will like to start from an unusual position to ask why you think your mother might just be seeking attention. It is not unusual for a 64-year person to complain of low back pain. This could be caused by so many factors such as Osteo arthritis, mechanical derangements of the spine, and being overweight.  Most of us also suffer from back pain without knowing the cause. You have mentioned that she struggles to get out of bed without assistance. The mattress might need to be examined because it may not be appropriate for her. Saggy or very hard mattresses can cause back pain. We shall in one of our series discuss mattresses and back pain. Usually, for a person of that age, the commonest cause of pain is Sacroiliitis. This can cause pain in your mother’s buttocks or lower back and can extend down to one or both legs. She might not be seeking attention. In some cases, you may not even see this when the X-ray of the low back is taken. This is why most people will think your mother is seeking attention.

Kelechi, as mentioned earlier, there are several causes of low back pain. These range from wear and tear of the bones resulting from arthritis, or reduced bone density to cancer of the bone. The most common complaint of back pain is the one we all refer to as “slipped disc” The truth is our discs don’t slip but they burst because of weaknesses of the fibers that should hold the natural cushion between the vertebral bone in place. As we age, these fibers become weak and could tear or burst. There are so many structures that can also cause pain around the waistline. The joint around the dimples of the waistline is one such example. Kelechi, when there is a problem around the dimples, the individual is neither able to walk nor stand. Your mother might be experiencing such symptoms and therefore might not be seeking attention. Having said that though, most people have at different times used back pain for malingering and an unjust reason not to want to perform certain tasks. Please, your mother has no such reason to seek attention However, if you strongly feel that she is, please consult your general practitioner. There could be a reason to refer her to a psychologist.  However, before you do that, can you please confirm if your mother has strained her back at any time by carrying something heavy or doing some laundry or other household chores unassisted? Most of these chores might also cause muscle strain hence a painful back.

Muscle strains are the most frequent cause of back pain. The most common are those that affect the lumbar (low-back) muscle, caused by stretching and bending in abnormal ways that make the ligaments stretch or tear. The pain can be acute or build up over time and become debilitating. If indeed she has muscle strain, please go to the nearest physiotherapy practice for a thorough assessment and treatment. She will also be taught how to manage her postures in sitting, lying, and walking.

Staying active with medication and alternating hot and cold treatments can help with long-term relief and management.

The other possible cause of back pain is overweight. So, Kelechi, if your mother is overweight, she will occasionally suffer from back pain. Researchers and clinicians have always warned about the effect of weight and height on spinal load, weight has a stronger effect than height in most cases. Obesity brings with it a greater risk of back pain, specifically in the lower back, for so many people. Your mother might just be one of them. Carrying excess weight in the abdomen and pelvis is most problematic because it shifts the pelvis forward, placing excess strain on the lower back. To treat this, if that is the problem,  she will have to commence a weight loss programme. I recommend that she sees a physiotherapist for an assessment and a prescription for an appropriate exercise programme.

Back pain is also common in the young population. Poor sitting and standing postures are known to cause back pain in the younger population.  The way we lift and carry bags might also lead to back pain.

Your mother would need to consult a general practitioner or a family physician for a thorough examination so that appropriate medication will be prescribed along with a referral for physiotherapy.

Best Wishes