Health: `I thought it was only backache'

After visiting a string of experts, Andrew Taylor discovered the cause of his back pain. But why did it take him 18 months to get the chilling diagnosis?
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The Independent Culture
Go to a doctor complaining of a bad back, and the response you can expect is similar to the one you would get if you told a barman that your wife didn't understand you. There's a sort of sympathetic contempt for back pain - a feeling that everyone gets it, that there but for the grace of God go I, and that you just have to learn to live with it. My back had nagged at me for years - leaving me alone for months, then jabbing me without warning. But then, after a bout of pneumonia, it came back with a vengeance. I knew it was time to get something done.

The pneumonia should have rung alarm bells, but it didn't. So should the fact that the pain was somehow different from anything I'd felt before - a constant, debilitating ache, rather than sudden flashes of agony. I couldn't run, or even walk fast; stepping unexpectedly off a kerb sometimes laid me out, gasping in the gutter. But pain is hard to describe; once you've said, "It hurts just - there, doctor", you've gone as far as most people do with their GP. I guess I should have tried harder to find the words.

I began a 12-month search for a cure, which started with painkillers and muscle relaxants from the doctor, which I took with a knowing curl of the lip - I wanted to find the source of the pain and sort it out, not just ease the discomfort. Then there was an osteopath who tugged me into impossible positions and finally dashed my optimism by admitting he couldn't help, and a chiropractor who eased the worst of the pain for a while. She, to her credit, told me that she thought I was seriously ill, but I didn't want to listen to that; after all, I'd seen a doctor.

An acupuncturist, next, measured five pulses where the doctors had looked for one, and stuck needles in my feet. I really wanted it to work, but I ended up more or less where I'd started.

Along the way, there were hearty physiotherapists, X-rays and scans, and a serious-faced chest specialist who sent me for yet another X-ray with the cheery thought that the pneumonia and the bad back might be linked by a cancerous tumour that had spread from my lungs - an infinitesimally small possibility, but one that ruined my week before it was ruled out. If I could have found a woman in black with a pointed hat and a bubbling cauldron of bones, I believe I would have gone to her too - and she might have done me just about as much good.

Chris Bulstrode, professor of orthopaedic surgery at Oxford's Nuffield Orthopaedic Centre, has little time for prevailing treatments of back pain, whether conventional or unconventional. "Practically all back pain will get better on its own," he says. "The only thing to do in the meantime is to control the pain, and that's best done by a combination of painkillers such as Nurofen and paracetamol, which you can buy over the counter. The vast majority of patients shouldn't go to their GP," he adds, "because in the end, he will push them on to a back surgeon, and the golden rule is: `Don't go near a surgeon'. Surgeons are there to cut, and most back problems aren't improved by cutting."

But there are exceptions to his rule. If you feel numbness down your legs, or if your feet feel weak so that you unexpectedly trip over the edges of rugs and carpets, then you should spell out your symptoms with care.

"Symptoms like that can be a sign of a slipped disc putting pressure on a nerve - though even then, more than 90 per cent of cases will get better on their own, given time. If the symptoms are serious, the doctor may decide to operate at once - though that should be a decision based on the numbness and weakness, not on the degree of pain the patient is suffering."

And you should be more precise than I managed to be in describing the sort of pain you are suffering. Back pain caused by disease rather than mechanical injury is exceptionally rare - but one of the signs of it, apart from numbness and weakness in the legs and feet, is a different sort of pain.

"It's a constant, boring pain that keeps you awake, and it may be accompanied by sweating and a general feeling of illness," says Professor Bulstrode. Discitis, for instance, is a bacterial infection in the space between the vertebrae, often linked to a urinary tract infection. Once diagnosed, it's highly susceptible to antibiotics - one of the few back problems that's readily treatable. Other diagnoses are more serious - myeloma, or bone-marrow cancer, for instance, or a secondary tumour spreading to the back from elsewhere in the body.

It is extremely rare - experienced surgeons will say they've found it only once or twice in 20 or 30 years of dealing with back problems. But it's a possibility that GPs ought to be aware of. A year after my first pneumonia I had my first, long-overdue, lucky break - though it didn't feel like it at the time. I had another bout of pneumonia.

Curing that was no problem - and the blood tests they did to see why I seemed to be so susceptible finally gave us a diagnosis. It was almost a relief to be told I had multiple myeloma - a bone-marrow cancer, producing tumours all over the body, and affecting 1,500 people a year in Britain. I had drawn the short straw out of a very big bundle.

Eighteen months, a course of chemotherapy and a bone-marrow transplant later, the signs are that I've been lucky. The cancer cells are all gone, and the prognosis is good. But the gods who rule over complex medical care never give all their gifts to one person. Now and then, just in case I forget, my back gives me hell.

THE BACK FACTS

Back pain is often caused by poor conditions at work, and is particularly prevalent in nursing, construction, agriculture, retailing and also the food industry.

About 120 million days of medically certified sickness absence owing to back pain are recorded every year.

Back pain costs the UK economy approximately pounds 6bn in lost production.

Back injuries cost the NHS pounds 480m a year.

Statistics have shown an increased prevalence of back pain among 16- to-24-year-olds. Some of this may be caused by heavy, badly designed school- bags, which are often carried on one shoulder.

Walking and swimming may help to alleviate back pain

In most cases, no more than 48 hours' bed rest is advisable, but you should always consult your doctor.

Back treatment could be revolutionised by a recent discovery. Scientists at the Washington University School of Medicine, St Louis, have restored movement to rats with damaged spinal cords, using nerve cell implants. The technique may be adapted for humans in the future.

For further information, write to BackCare: National Organisation for Healthy Backs, 16 Elmtree Road, Teddington, Middlesex, TW11 8ST, with a cheque for pounds 3 payable to BackCare

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