Lower back pain after drinking

The most common type of back pain is simple backache, where the pain is usually in the lower back and occasionally spreads to the thighs or buttocks. It is caused most often by a sprain or minor tear to a ligament or muscle in the back, usually from awkward or heavy lifting, twisting or bad posture (such as sitting at an incorrectly designed workstation or desk). Usually called nonspecific low back pain, there is no specific problem or disease that can be identified as the cause of the pain. The severity of the pain can vary from mild to severe.

A smaller number of cases are due to a nerve being trapped as it comes out from the spinal cord and this can be due to a slipped disc, a bad muscle tear or other problems such as arthritis. This type of nerve root pain is often called sciatica and pain is felt along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot, and the pain in the leg or foot is often worse than the pain in the back.

The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. In cases where sciatica is caused by a slipped, or prolapsed disc in the back, part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc and the prolapsed part of the disc can press on a nerve nearby and cause the pain.

Sometimes a pain may develop immediately after you lift something heavy, or after an awkward twisting movement, and sometimes it can develop for no apparent reason. Some people just wake up one day with low back pain and this can range from mild to severe, with the pain sometimes worsened by coughing, sneezing or moving. If a nerve is trapped there may be pins and needles or numbness down one leg but most cases of back pain ease within a few weeks. However it is quite common for further episodes to occur in the future.

Although some people find their back pain is worse after drinking alcohol, there are few good clinical studies that show why this might be the case. However, one consistent reason may be dehydration.

Alcohol blocks the creation of a hormone called vasopressin that is produced in the pituitary gland in the brain. This helps to regulate the amount of water we have in our body and so when we drink alcohol, we can become dehydrated by producing more urine. This in turn can slightly dry out the spongy discs between our backbones - called the intervertebral discs - which act as shock absorbers in our back. As a result, inflammation around these can occur with back pain being the main symptom.

Dehydration is also a risk factor for the development of kidney stones. These can cause pain in the back and side of the body, which is often very severe. If you are prone to these developing, always make sure you stay as hydrated as possible including drinking water with each alcoholic drink you have.

How to reduce your alcohol consumption

If you regularly drink more than 14 units of alcohol a week (14 units is equivalent to 6 pints of average-strength beer or 6 medium glasses of wine) then try our Healthwords tips to cut back. However, if you have physical withdrawal symptoms, like shaking, sweating or feeling anxious until you have your first drink of the day, speak to your doctor before trying to cut down or stop drinking - if you are a regular heavy drinker it can be dangerous to stop drinking suddenly.

Ways to cut down include:

• Choosing a lower strength drink, or a zero alcohol version
• Making every other drink a soft one, starting with your first
• Staying out of ‘rounds’ of drinks - this helps you stay in control of your drinking
• Not topping up your glass. It’s easy to lose track of how much alcohol you’ve really had
• Only drinking alcohol with your evening meal and not having any drinks beforehand or afterwards
• Aiming to have three or four days a week alcohol-free.

Treatment for back pain depends on what kind of pain you have. Acute back pain usually gets better without any treatment, but you may want to take painkillers such as paracetamol or ibuprofen to help ease the pain - these are available from our shop. Exercise and surgery are not usually used to treat acute back pain.

Chronic back pain is usually treated with painkiller (analgesic) medication – these include over-the-counter drugs such as paracetamol and non-steroidal anti-inflammatory (NSAID) tablets like ibuprofen as well as topical analgesics like creams and ointments that can be rubbed onto the skin over the site of pain.

Your doctor may prescribe stronger NSAIDs if necessary as well as muscle relaxants and some antidepressants that can be helpful with chronic back pain, although these do not work for every type of back pain.

If back pain is not relieved by medication, some people try complementary and alternative treatments. The most common of these treatments are manipulation such as chiropractic or osteopathic treatment, transcutaneous electrical nerve stimulation (TENS) treatment where a small box over the painful area sends mild electrical pulses to nerves to help block pain signals, and acupuncture may also be helpful in some people.

Most people with chronic back pain do not need surgery and this is only required if other treatments do not work. You may need surgery if you have a slipped disc – here, one or more of the discs that cushion the bones of the spine are damaged and the jelly-like centre of the disc leaks and presses on a spinal nerve causing pain. Other conditions that may require surgery include spinal stenosis where the spinal canal becomes narrow and causes pain, spondylolisthesis – where one or more bones of the spine slip out of place and osteoporosis where weakening of the bones causes them to crumble and occasionally fracture.

Rarely, when back pain is caused by a tumour, a severe infection, or a nerve root problem called cauda equina syndrome, surgery is needed right away to ease the pain and prevent more problems occurring.

Most cases of back pain are nothing to worry about and will improve within a few weeks. However, there are certain circumstances when you should seek medical attention:

• if your back pain has not started to improve after 6 weeks
• if your back pain started after a significant fall or accident
• if you have a history of cancer
• if you have sciatica affecting both legs, numbness around your bottom or problems with your bowel or bladder control
• if you are feeling generally unwell with a fever, and no other flu-like symptoms
• if you’ve been taking steroid tablets for several months
• if the pain travels up the back or into the chest
• if you’re aged under 45 and get severe back pain and stiffness first thing in the morning every morning, lasting for 30 minutes or more, and this has persisted for 3 months or more - often movement will make it feel better
• if you’re losing weight for no obvious reason
• If you have any of the above features associated with your back pain your doctor may refer you directly for investigations or to a specialist to identify the cause for your back pain.