Last week I saw a patient who had been suffering with severe back pain for months. He hadn’t wanted to bother the doctor, but the pain had become so debilitating that he finally booked an appointment.
In the end it turned out to be a slipped disc, which can usually be treated with pain medication, rest and gentle exercises.
But his reluctance to trouble his GP disturbed me.
Research shows that nearly half of all Britons actively avoid seeing a GP for back pain – with a third of sufferers citing difficulty getting a timely appointment as the main reason for delaying care.
This may seem like a sensible approach. Nearly 80 per cent of people in the UK experience back trouble at some point, making it the country’s most common form of chronic pain. The NHS, meanwhile, is under immense pressure, and we’ve rightly encouraged people not to book appointments for every ache and niggle.
But while back pain is incredibly common, it can also be the first – and sometimes only – warning sign of diseases that are serious and occasionally life-threatening. And the fact that, most of the time, back pain isn’t caused by anything sinister is what makes it so easy to ignore the occasions when it is.
One of the biggest concerns is myeloma – the third most common blood cancer in the UK, with over 6,500 people diagnosed every year.
One reason it is so often diagnosed late is that its symptoms are remarkably easy to dismiss.
Research shows nearly half of all Britons actively avoid seeing a GP for back pain – a third of sufferers cite difficulty getting an appointment as the reason for delaying
The classic example is back pain. Patients with myeloma frequently say they assumed they’d pulled a muscle, often waiting months before seeking help.
Any back pain that persists for more than a couple of weeks without obvious improvement deserves a proper assessment. Your GP can arrange blood tests and, where appropriate, scans to rule out more serious causes.
With conditions such as this, early diagnosis matters. While myeloma remains incurable, treatments have improved dramatically, with many patients now living for years after diagnosis because treatment was started promptly.
Cancer is probably the last thing most people think about when their back starts hurting.
Yet myeloma isn’t the only disease where back pain can be the first clue.
Pancreatic cancer, one of the UK’s deadliest diseases, is notorious for being diagnosed late because its symptoms are often vague. Back pain is one of them. Pancreatic cancer commonly causes pain in the middle of the back, roughly where a bra strap sits, which can spread through to the shoulder blades or upper abdomen.
Women should also know that persistent lower back pain can be a sign of ovarian cancer.
The back pain caused by ovarian cancer can resemble persistent period pain deep in the lower back and is commonly accompanied by bloating, feeling full quickly or changes in urinary habits.
To be clear – the overwhelming majority of people with back pain will not have cancer. Far from it. But the trick is recognising when back pain has stopped behaving like ordinary back pain.
Health service advice says that anyone whose back hasn’t improved after three to four weeks should contact their GP.
The health service must do more to make it easier for patients to seek help for back pain – of any kind. In some parts of the country, waiting times to see a spinal specialist can stretch beyond a year.
What happens to those patients for whom there really is something seriously wrong?
We need to start treating back pain like the significant medical issue it is.
Could the secret to a longer life be enjoying yourself a little more?
I often think of Betty White’s famous quip that the secret to her long life – the Golden Girls star died in 2021 at the age of 99 – was to ‘avoid anything green’ alongside her usual diet of hot dogs, french fries and vodka.
As doctors we spend our lives lecturing people to not smoke, drink or eat an unhealthy diet. Yet I’m always astonished by some of my patients, well into their 80s and seemingly fit as a fiddle, who, like Betty, pictured right, have done the exact opposite of this.
Betty White, pictured in 2010, said the secret to her long life was ‘avoid anything green’ alongside her usual diet of hot dogs, french fries and vodka
So I’d love to hear from those of you who have made it to an advanced age and are still fighting fit or look far younger than you actually are.
Have you spent your life living in a saintly fashion? Or at some point does denying pleasures become counterproductive?
Please write in using the email address below and let me know your secret.
Your questions answered
Can I beat insomnia without medication?
I haven’t had a good night’s sleep for my entire adult life. I used to take sleeping pills, but apparently they aren’t good for you in the long term. What can I do instead?
Dr Ellie replies: Nearly five million adults in England struggle with insomnia – the sleep disorder that makes it difficult to fall asleep, stay asleep or get a good night’s rest.
Insomnia – with older people and women disproportionately affected – can worsen mental health problems, increase anxiety and contribute to physical symptoms such
as headaches, nausea and fatigue. It also doubles the risk of depression and increases the likelihood of developing obesity, type 2 diabetes and heart disease.
According to the National Institute for Health and Care Excellence (NICE), sleeping tablets should be avoided because of the risk of addiction and withdrawal.
They also don’t work well for many people and often fail to deliver quality sleep.
Instead, ask your GP about a referral for CBT-I – a specialised form of cognitive behavioural therapy for insomnia that can be done in groups or one-to-one.
It often includes techniques such as sleep restriction, where patients limit the amount of time they spend in bed, before increasing it as their sleep improves.
So-called sleep hygiene is also vital – it means creating the right conditions for sleep. This involves sticking to a regular bedtime, keeping your bedroom dark, using earplugs if needed and avoiding screens before bed. It’s also best to avoid eating, vigorous exercise and stimulants, such as alcohol, in the hours before bedtime.
For additional support, apps such as Sleepio guide users through evidence-based techniques that are designed to improve your sleep quality without medication.
Do you have a question? Email DrEllie@mailonsunday.co.uk
