Patients & Visitors

Pain Clinic


Back Pain

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Mechanical Low Back Pain

About one third of patients who visit the RUH Bath Pain Clinic suffer from mechanical low back pain. Isolated back pain, without pain that radiates down either leg and not associated with worrying symptoms such as weight loss, is very common. The key to management is to maintain mobility, flexibility and strength. It is much easier to ensure a return to normal activities by intervening early, and we would like all our patients to have been given simple advice to remain active. Patients should be reassured about the nature of their problem; it is very important that complete rest is kept to an absolute minimum. TENS is a simple intervention that may, where available, provide useful relief.

The Back Pain Network provides access to early supervised exercise throughout the region. Patients should be advised to attend classes wherever possible. Local swimming pools (e.g. Bath Sports and Leisure main Pool) may also provide GP Referral Sessions when patients can go along and exercise gently in warm water on the advice of their General Practitioner.

Patients who have evidence of Red Flags should usually undergo further investigation before referral to the Pain Clinic. The presence of Yellow Flags suggests that early referral to the Pain Clinic is warranted.

Non-mechanical Low Back Pain

Low Back Pain is very commonly mechanical – that is to say, it arises from a combination of musculoskeletal factors, including tense, tired muscles, some wear and tear in the joints and some disc degeneration. It is often of long duration by the time that a patient presents. Sometimes, however, back pain is much more specific to a particular problem. Back pain associated with pain that radiates down one or both legs (often sciatica), or pain associated with recent weight loss or new neurological abnormality are examples of non-mechanical low back pain.

The Bath Pain Clinic is happy to take patient referrals in the case of recent onset sciatic pain, as this condition often responds to early treatment with either epidurals or with neuromodulatory medications. We are also very happy to see patients with other pain, such as malignant pain, provided further investigation is underway or completed. The presence of red flags does not therefore preclude referral to the Bath Pain Clinic under such circumstances.

Red Flags

  • Gross neurology
  • Sphincter disturbance
  • Saddle anaesthesia
  • Upgoing planters
  • Weight loss
  • History of malignancy
  • Recent significant trauma
  • Severe thoracic back pain
  • Severe bilateral leg pain
  • Spinal deformity
  • Severe constant night pain
  • Gait disturbance
  • Fever or night sweats

Yellow Flags


  • Fear avoidance
  • Pessimism depression, expressed stress, anger and sometimes sleeplessness
  • Illness behaviour and adoption of the sick role
  • Passivity (external locus of control)
  • Helplessness
  • Tendency to see pain in a catastrophic light


  • Family: beliefs, expectations, reinforcement
  • Work: job satisfaction, difficulty working with pain, flexibility of employer, work options
  • Non-health problems (financial, marriage?)
  • Mobility and function
  • Hobbies and pleasures. Restrictions.

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