Health Do you have a problem youd like answered? If so, write to us at: Inspire magazine, 1 Cambridge Technopark, Newmarket Road, Cambridge CB5 8PB or email inspire@arthritiscare.org.uk Ask the doctor Whether its a health niggle or emotional problem, Inspires dr sarah Jarvis gets straight to the point Q i have long-term back pain. im not keen on strong painkillers, but my gP says paracetamol isnt suitable. What can i do? Sarah Weaver, Hemel Hempstead dr sarah jarvis answers: The National Institute for Health and Care Excellence (NICE) has just produced a long-awaited update on options for low back pain treatment. Frankly, some doctors are also struggling, because many of the treatment options weve traditionally given are no longer recommended. This is a real dilemma, as a 2016 study in the British Medical Journal suggested that one third to one half of adults in the UK live with chronic pain. Low back pain and osteoarthritis are among the biggest contributors to this. The new guidelines do not recommend paracetamol alone for management of low back pain; they only recommend it in conjunction with weak, opioid-type painkillers such as codeine for acute low back pain if you cant take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. NSAIDs are still on the table, but doctors have become more aware of their risks, such as to the kidneys and heart, as well as to the stomach. Most of these risks are higher for long-term and high-dose usage. If youre taking NSAIDs for anything more than a few days, you should be using a tablet such as omeprazole to protect your stomach. Several other forms of non-drug treatment including acupuncture, corsets, transcutaneous electrical nerve stimulation (TENS) and traction are also out of favour. Spinal manipulation and massage are still recommended, but only as part of a package including exercise. Instead, the latest NICE guidelines switch the focus to group exercise programmes (biomechanical, aerobic, mind/body or a combination of these) for flare-ups of low back pain, with or without sciatica. For persistent low back pain, there is now a recommendation to consider psychological therapy as part of a combined physical/psychological approach. This may be particularly useful for people who are worried about making their condition worse by doing the physical exercises, if previous treatments havent worked, or for people who are struggling to get back to work. There may be more on offer in your area than there was last year, so speak to your GP about getting a referral. It may also be worth thinking about complementary therapies. Studies for GOPO, a supplement based on rosehips, have shown it can reduce pain and stiffness in those with low back pain, as well as osteoarthritis of other joints. Ask the expert bharti raJpara is from Arthritis Cares Helpline team. You can call the Helpline free on 0808 800 4050 Q im finding it very hard to talk to my partner about my rheumatoid arthritis (ra). We have two young children, whom i practically look after by myself, and i also run the house. he doesnt seem to understand how much pain i am in and how difficult life is for me on a daily basis. i dont know what to do. is there any help available? Reema, 21 Bharti answers: Living with RA is tough enough, but when you have young children to look after as well, life can seem impossible some days. Its really important that your healthcare team has your treatment sorted. But whats crucial is that you have the support, understanding andwillingness to lend a helping hand from the people closest to you. The support you receive can make thedifference between managing your RA well, and not managing at all. There are lots of reasons why partners may find it difficult to give support. Sometimes they dont understand how painful and exhausting it is to live with RA; sometimes they cant accept whats happening to you, so they think if they close their eyes it will go away. Finding a way to communicate to your partner how tough things are isnt easy, but it can be done. Our booklet Living with RA may be useful in explaining how it affects you. Is there anyone that you both trust and respect? Someone your partner listens to, who can explain to him exactly what youre going through, and how he can best support you and your children? The reason I suggest this is because sometimes when we try to talk to our partners especially if werein pain and exhausted it comes out wrong. When this happens, both ofyou end up feeling hurt and frustrated. Its important not tofocus on what hes not doing, but toencourage him, by explaining that the more he helps, the better youre going to feel. Our Feelings Matter: Emotional Wellbeing and Arthritis booklet could help your partner to understand what you are experiencing. You can contact Arthritis Cares free Helpline on 0808 800 4050 for an informal chat in confidence. Were open Monday-Friday, 09:30-17:00. For more information, visit arthritiscare.org.uk/livingwithra