Could your back pain be cancer?

Statistically speaking, your low back pain is probably nothing. According to World Health Organisation, about 90% of low back pain is non-specific in nature. In other words, they don’t have a clear cause and is not link to anything, including cancer.

I just read about Jo Bromilow in the news today. She is a lady from the United Kingdom who was diagnosed with pancreatic cancer, after experiencing back pain and a decrease in appetite. Unfortunately, her cancer is stage four and she was only given 12 months to live.

According to Bristol Post, Bromilow’s symptom included “couldn’t eat anything”. As a general rule of thumb, you should also seek medical advice if you find yourself struggling to eat. While seemingly unserious, the differentials for loss of appetite include cancer, AIDS, chronic lung disease, and severe organ failure (e.g., kidney, liver, heart).

Back pain can be (but is rarely) a symptom of cancer

If you do a quick Google, y0u will realise that a lot of people with cancer does experience back pain. Pain is almost synonymous with cancer with up to 90% of cancer patients experiencing pain. The bigger question we are interested in is how many percentage of people with back pain may have cancer?

According to a study involving 6622 participants, only 1% of new back pain cases are caused by tumours. Between 1-5% are the result of more serious conditions such as cancer, fracture, infection, or cauda equina syndrome. In other words, most of back pain are not of serious pathology, and we don’t need to worry too much about it.

Red flags of low back pain

This is a good time to revise the red flags of low back pain. Red flags refer to signs and symptom that may suggest the possibility of a more serious underlying pathology, and that further investigations may be required.

In other words, if you experience red flags symptoms, you should definitely get it checked out by a medical doctor or the A&E department. The doctors will investigate your pain and rule out any serious pathologies. Following which, they will be able to refer you to the appropriate department for further management.

According to the National Neuroscience Institute, the red flags of low back pain are:

• Unexplained weight loss
• Loss of appetite
• Neurologic symptoms; e.g., numbness, weakness in legs
• Older age (above 50 years old)
• Fever
• History of cancer
• Problems passing urine or bowel motions
• Back pain caused by an accident or trauma

If you have unexplained weight loss, loss of appetite, neurological symptoms, fever, you may want to get it checked out at the nearest polyclinic or by your local GP.

If you are experiencing difficulty with urine or bowel movements, especially with loss of sensation around the anus, you definitely want to head to the nearest hospital. These symptoms could potentially be from cauda equina syndrome, and it is considered a medical emergency.

Cauda equina syndrome is fairly rare, it can be caused by large disc herniations, trauma, infection, tumours, etc. As part of treatment, surgical decompression will be performed to relieve pressure on the affected nerves. It is largely agreed that recovery outcomes are best if treatment is within 24 hours of onset.

First-line treatment for non-specific low back pain

A lot of people always asked why do I not offer chiropractic adjustments as a chiropractor. And the reason is because spinal manipulation is NOT the best treatment for low back pain. The first-line treatments, generally agreed by all clinically guidelines, are exercise, staying active, and education (i.e., knowing the right facts about back pain).

This should allude to why people say that you have to keep going back for adjustments once you start seeing a chiropractor. It is cos it’s not really a good long-term solution. In research literature, we call it low value care. Because, you have to keep paying money to get the same results.

Cognitive behavioural therapy (CBT) is now a first-line treatment. The influence of mental health and well-being on a person’s pain experience cannot be disputed. CBT can help with getting people active again and also to reframe their pain to more helpful beliefs.

In doing so, it can also help pain patients find freedom from pain. Because CBT is generally only offered by psychologist, and I am not a psychologist (yet), this is not something we offer at Square One Active Recovery. Maybe next time though!

Cancer pain treatment options

Most people with cancer will also receive pain management for their cancer pain. Medication from paracetamol and anti-inflammatory drugs to opioids (e.g., Tramadol)  is general the go-to treatment for cancer pain.

If the pain is severe and medication does not seem to help, pain specialists may look into other treatment options such as nerve blocks.

For those preferring conservative care, acupuncture is also a treatment option.

Exercise for people with cancer

I know this sounds ridiculous but people with cancer can exercise. In fact, exercise can be helpful for cancer pain. I guess we envision people with cancer to be suffering, and maybe frail. So, exercise is not something that comes to mind.

The good news is people with cancer can exercise. Surprisingly, research have shown it does not worsen cancer pain. There is also some evidence to suggest that it can be helpful. Some studies showed that cancer patients who exercise regularly experience less side effects than those who don’t!

There is no fixed formula or exercise recommendations for people undergoing cancer treatments. It is best to speak to your oncologist or healthcare provider about it.

Singapore Cancer Society runs a rehabilitation programme that caters to people from newly diagnosed / pre-treatment phase to those who are already discharged from hospitals. The out-of-pocket fees start from as low as $5 to $90.95 for Singaporeans.