Ask the GP: is exercise the right prescription for back pain?

Question: I went to see my doctor recently because I had back pain. Instead of giving me painkillers she has advised me exercise and physiotherapy. Is that going to help?

Dr Nina replies: Pain is a very subjective symptom and how we cope with it is largely individual as well. Medicine has advanced over the years and we now have many different types of pain remedies. What is important to realise is that pain relief does not just come in the form of potions and pills. Other forms of therapy can be equally important.

It is reasonable to try taking some paracetamol or ibuprofen for mild injuries and discomfort but if pain persists or is severe, I would always advise seeing your doctor.

Pain can be due to an assault or injury. It may be due to stress on nerves or internal organs, or it may be due to psychological stress or strain. Most commonly pain that is prolonged or persists is due to a combination of causes.

Back pain is one of the most common reasons people attend their GP. There are many causes. These can include infection or inflammation of the urinary tract, bowel or pelvic organs or may also be due to injury or strain of the skeleton and the ligaments, tendons and muscles that support it.

Your GP can examine you to help identify a cause. In the majority of cases back pain is caused by musculoskeletal strain. The exact trigger isn't always obvious. It may seem appropriate to go to the press and take some painkillers but this isn't necessarily the best way to go.

Inflammation is part of the process that leads to healing. Taking painkillers for a few days for severe pain may help but taking them for a more prolonged period may actually hinder the healing process. Firstly you are more prone to re-injury as the analgesia may mask the symptoms of strain. Secondly healing may be slowed when the inflammatory process is blocked.

Physiotherapy is absolutely key to muscle recover and repair. Don't underestimate the benefits this may have. A qualified physiotherapist can properly assess the injury, muscle strain and strength and arrange and execute an appropriate rehabilitation programme. Exercises are key to this.

An exercise prescription from your physiotherapist is no different to a medical script from your doctor and in order to ensure healing you must follow it precisely. Exercising long term will help keep you supple and well. Medication only helps short term.

Question: I have attended my GP a number of times because I have a feeling of a lump in my throat. It comes and goes. I am able to eat and drink and this actually helps sometimes. My GP tells me I am fine but I am worried.

Dr Nina replies: It sounds like you might be suffering from a condition called globus sensation. This condition has also previously been called globus pharyngeus. It is an uncomfortable sensation of a lump or something in the throat. This condition is quite common accounting for nearly 5pc of attendance at ear nose and throat clinics.

It is most common in those in middle age and although it occurs equally in both sexes, women more commonly attend the doctor to complain about it.

The feeling of a lump or something in the throat tends to come and go. Importantly it does not limit eating or drinking and food and fluids do not catch on the way down.

In fact, consuming liquids or food may relieve symptoms in some. Symptoms may be most common on swallowing saliva. Globus doesn't cause pain. It was thought for many years that this condition was purely related to anxiety or panic.

We now know this isn't the case. These conditions may contribute but there can also be underlying problems with the sinuses and nasal passages or with the throat, oesophagus or stomach.

Silent acid reflux is felt to be one of the more common causes. Taking some anti-acid medicine may help. Another cause may be a chronic post-nasal drip which can irritate the throat causing an uncomfortable sensation. Lastly, specific anatomical features of the base of the tongue and pharynx may play a role.

It is important to attend your doctor for review. If there is difficulty swallowing fluids or food, if your weight has changed, if there is pain or progression of symptoms, or if you have a cough, shortness of breath or sweats or other causes need to be ruled out.