Life style
Why isn’t your back pain improving with treatment!
Understanding complex rheumatological conditions requires both medical expertise and compassion. In this exclusive interview, Dr. Aruna Caldera, Consultant Rheumatologist, speaks with Zanita Careem about the growing burden of early diagnosis, advances in treatment, and how greater awareness can help patients lead healthier and more fulfilling lives. The discussion explores how lifestyle posture, inflammation and underlying rheumatological conditions, can contribute persistent pain, while highlighting ways to protect spinal health and maintain mobility
Back pain is one of the most common health problems worldwide, affecting many people at some point in their lives. Most episodes of acute low back pain improve within weeks, often with conservative care, though recurrence is common. Unfortunately, there is a proportion of patients who continue to suffer long term.
A large number of these patients are treated for common causes of back pain, such as degenerative changes (wear and tear), whereas the actual cause of their back pain is for totally different reason/s, hence the poor outcome. The main issue in our setup is the public perception of back pains can be cured with local applications alone, whereas the reality is totally different. Pain may reduce temporally with a local application, whereas the underlying root cause remains unaddressed.
Let’s look at why back pain sometimes does not improve with common treatments. Here, I am mainly referring to chronic back pain (long-standing back pain). However, I will also briefly discuss acute and subacute (back pains with a short history) back pain because of their potential seriousness.
When evaluating patients with back pain, a considerable number fall into the category of non-specific back pain, meaning a clear diagnosis cannot be identified. The clinician’s experience and diagnostic skills play a major role in this. When a definite diagnosis can be made, patients often require specific treatment, tailored to that condition. “Paracetamol for every fever” theory cannot be applied for chronic back pain.
Before prescribing treatment for back pain, the clinician should first have a clinical diagnosis, and then only decide which investigations, such as blood tests, X-rays, CT scans, or MRIs are actually needed. Radiating pain down the leg (sciatica), which is commonly associated with back pain, is an important symptom, but should always be interpreted in conjunction with the patient’s history, physical examination findings, and imaging where appropriate. An incorrect clinical diagnosis can lead to unnecessary investigations and may delay identifying the true cause. Nerve root compression, seen on MRI, may not necessarily explain a patient’s symptoms and should always be interpreted in the context of the clinical findings. Furthermore, people with similar MRI finding may not have back pain.
This is why it is important that back pains not settling for primary treatments need to be considered for evaluation by relevant specialists early. Some conditions, such as inflammatory back pains due to axial Spondyloarthritis (previously known as ankylosing spondylitis), may require early specific treatment to prevent complications.
When evaluating a patient with back pain, it is essential to watch for “red flag” symptoms that may indicate serious underlying disease. Conditions, such as spinal cord compression, spinal tumours (often spread from breast, prostate, kidney, or lung cancers), multiple myeloma, spinal epidural abscesses (collections of pus), osteomyelitis (infection of vertebral bones), spinal tuberculosis, must be identified and treated as quickly as possible. Unfortunately, the X-ray, which is the go-to investigation in back pain, may be normal, and blood tests may not reveal specific findings, even in a patient with a serious underlying condition mentioned above! Without proper treatment, these conditions can result in permanent disability, or even death.
Many patients with these serious conditions may present late to relevant specialist care. One main reason for that is the capability of even non-specific treatments to temporarily reduce the pain, at least initially.
Chronic or long standing back pain has numerous causes. Osteoporotic spinal fractures (sometimes occurring without the patient realising it!), radiculopathy (compression of nerve roots exiting the spine), spinal stenosis (narrowing of the spinal canal), spinal deformities such as scoliosis and kyphosis, axial Spondyloarthritis (previously known as ankylosing spondylitis; a chronic inflammatory rheumatic disease that can cause significant disability if untreated).
We must not forget that cause of the back pain is not always related to the spine. Kidney and ureteric stones, certain kidney diseases, enlargement of major abdominal blood vessels (aneurysms) and bleeding within them (aneurysmal rupture), reactivation of herpes zoster, some gynaecological conditions, psychological causes, fibromyalgia, etc.
There are other rheumatological conditions which can present with back pain. Sometimes these diagnoses are missed because the back pain is attributed to the changes in the spine X-ray due to wear and tear. Greater Trochanteric Pain Syndrome (GTPS) (pain arising from structures around the outer hip, often related to gluteal tendinopathy and sometimes involving the trochanteric bursa), adductor tendinitis (inflamed inner thigh muscle which may have associated groin pain), piriformis syndrome (sciatic nerve compressed by piriformis muscle in the butt), Bertolotti’s syndrome (lowest lumbar vertebra fusing with the sacrum), coccydynia (tailbone pain), arthritis affecting the hip, are some examples.
When the actual cause of back pain is not identified, treatments aimed for findings in X-rays, CT scans, or MRI scans may not be successful. One reason is that in many people, over the age of 40, MRI scans commonly show degenerative changes, especially at L4/L5 and L5/S1 levels, such as disc degeneration and minor exit nerve root compression, even when the person has no symptoms at all! Electrodiagnostic studies (nerve conduction tests) may not always correlate with MRI findings, as they assess nerve function rather than anatomical appearance.
Treatment should primarily be based on the clinical diagnosis derived from the patient’s history and physical examination. Treating the scan report, rather than the clinical diagnosis, may lead to poor outcomes in certain patients.
Another major drawback is that if the clinical diagnosis is wrong, the MRI may be focused on the wrong area. For example, if Spondyloarthritis is suspected, MRI of the sacroiliac joints should be included in the protocol.
Poor clinical information on imaging requests may contribute to delayed diagnosis, although delayed recognition and referral are also important factors. Sometimes MRI findings are less informative because the imaging request lacks sufficient clinical details to guide image acquisition and interpretation.
The treatment is multimodal. Evan a layperson would know he/she may need some medicines to reduce the pain (at least initially) and some form of physiotherapy. Actually, this is true for all back pains and this is where the problem actually starts. Many patients will experience at least some temporary improvement with basic treatments, but actually they aren’t getting the ideal treatment. Some may need muscle relaxants, some may need guided root injections, some may need epidural injections, some may need surgery immediately, some may need surgery later, some may require surgery / minimally invasive surgery (MIS), some may require nerve ablations, some may need bursal injections, some may need intra articular injections, some may need even disease-modifying anti-rheumatic drugs (DMARDs). That is why the diagnosis should be as accurate as possible and made by a doctor essentially which isn’t always the case in the Sri Lankan setting unfortunately.
We all are aware of the disaster if a cancer deposit in the spine is missed. It is often overlooked that missed osteoporosis related wedge fracture may the first sign of an impending hip fracture. What public may not be aware of is that up to 1/3 of patients, who suffer hip fractures, die within 12 months. So much so, a wedge fracture in the spine (however small) requires evaluation for osteoporosis and initiation of treatment where appropriate to prevent a hip fracture and prevent further spine fractures.
Young people with back pain have a different set of diagnostic priorities. Significant degenerative spinal disease is less likely to explain chronic inflammatory-type back pain in a 30-year-old patient, and axial Spondyloarthritis should be considered. Furthermore, X-rays of the spine as well as the involved sacroiliac joint could be also normal! These patients may require MRI of the sacroiliac joints, particularly when clinical suspicion remains high, despite normal X-rays.
What if the patient is not improving? It may be due to an incorrect diagnosis, disease progression, poor adherence to treatment, psychological factors, central sensitisation, treatment limitations and other comorbidities.
As you’re reading this, you may be sitting there holding your back and wondering why your back pain never got better. The reason may very well be one of the issues I have mentioned above. Also remember that reduction in pain does not mean an arthritis condition has been dealt with. Persistent or concerning back pain should not be ignored and should be assessed appropriately.
Life style
Meet the author rewriting the rules of children’s fiction
Representation matters:
By Ifham Nizam
“There are no books written about pirates with prosthetic limbs, sporting blades, or racing wheelchairs—that is, until now,” says award-winning international children’s author Jann Weeratunga, whose Polly’s Piralympics series is challenging conventional ideas about who gets to be the hero in children’s literature.
For Weeratunga, representation is not simply about placing a disabled character somewhere in a story. It is about putting that character at the centre—leading, competing, winning, making friends, overcoming challenges and, most importantly, having adventures on their own terms.
Her books are designed not merely to be read, but to be experienced. Through interactive pages, children can colour, draw, write and respond to the stories, leaving something of themselves behind as they explore themes, ranging from disability and bullying to friendship, resilience and family.
At the heart of her growing literary brand is Polly’s Piralympics, a series in which disability is not presented as a limitation, but as part of a character’s identity and adventure.
The inspiration came from an unexpected moment during the closing speech of the 2012 London Paralympic Games by Sir Philip Craven. He recalled a young boy looking at an illustration of a pirate with an eye patch, a hook, a parrot and a wooden leg.
When his mother asked who the figure was, the boy replied that because the man had only one leg, “he must be an Olympian.”
The story moved Weeratunga deeply.
That moment of innocent perception—where disability was associated with sporting achievement rather than limitation—sparked the idea of Polly and her extraordinary Piralympic world.
In the series, Polly, a bird-napped African parrot, finds herself bullied in a Scottish pet shop before being rescued by Captain Hake. Their shared one-eyed view of the world becomes the beginning of an unusual friendship. Captain Hake teaches Polly the ways of a pirate, while Polly creates the Fellowship of Pirates and the Pirates Paralympics.
Soon, pirates from around the world are competing in events ranging from three-legged races and climb-the-rigging gymnastics to walk-the-plank diving and even a MasterChef competition.
It is an imaginative world, but behind the humour and adventure lies a serious message about inclusion and leadership.
Weeratunga recalls one school visit that brought home to her exactly why the books mattered.
A student with a prosthetic leg embraced her and said: “Thank you for writing these books for me, Auntie.”
The words left her overwhelmed.
“That was why I had written these books,” Weeratunga reflects.
Her journey towards becoming an author, however, began long before Polly sailed into the world of children’s fiction.
Earlier in her life, Weeratunga was a Scout Leader in the UK, where volunteering became a way of life. She subsequently spent a decade in Sri Lanka, falling in love not only with a Sri Lankan, but with the country itself.
After her husband died just four years into their marriage, she joined five other women to establish a small school in Senarathwela to teach English to those who wanted to learn. Many of her pupils, subsequently, found employment at the newly opened Victoria Golf Course.
When she returned to Sri Lanka in 2025 and revisited the village and golf course, she found a landscape transformed by new roads, homes, shops and businesses. But the people she had taught remained.
“The village is unrecognisable, with new roads, homes, shops and businesses, but my dear pupils were still there as Caddies, Caddy Master and Golf Pro. I was so proud of them,” she says.
Her connection with Sri Lanka deepened further during one of the country’s darkest moments.
On Boxing Day 2005, while holidaying in the UK with her recently widowed mother, Weeratunga was woken by the words: “Something terrible has happened in Sri Lanka.”
She rushed to the television and witnessed the devastating aftermath of the Indian Ocean tsunami.
That very day, she established a non-profit organisation to raise funds and take relief to Sri Lanka. With support from local McDonald’s franchises, schools in Ferndown, the Mayor of Ferndown, freight companies and her friend Mr Wijekoon, a local Grama Niladhari, she helped rebuild lives in Arugam Bay.
The experience was hands-on and deeply personal. A family’s home had been swept away, and days were spent persuading surfers to help construct a future for her adopted family.
A Montessori was established on the hill, within the Buddhist temple grounds, while evenings were spent crafting, building and working with a small but effective generator.
Meals of rice and curry, prepared by the family’s sisters, using provisions donated from Senarathwela, brought the long days to a close.
When Weeratunga returned to the family, in 2025, she was able to see how far they had come.
Today, living in South Africa, she continues to draw inspiration from the landscape around her.
“Travelling—it leaves you speechless and then turns you into a storyteller,” she says, echoing the famous words attributed to Ibn Battuta.
And storytelling has become her way of opening conversations with a new generation.
While Polly’s Piralympics remains the flagship of her children’s publishing brand, Weeratunga’s wider collection explores a range of issues that matter to children and parents.
Terry and the Bully gives children practical and empowering ways to stand up for themselves, transforming a difficult subject into a story through which young readers can explore courage and self-confidence.
In Evie Visiting Grandma, children encounter the sensitive experience of visiting a loved one who now lives in a residential home. Rather than avoiding a potentially difficult subject, the story gently opens the door to conversations about ageing, family and change.
Terry the Toucane explores another universal childhood experience—the challenge and beauty of being different. Its central message is simple: being different should never prevent us from developing deep and lasting friendships.
Then there is Captain Bluebird, a resilient and entertaining adventure exploring what happens when Captain Bluebird receives a brand-new ship.
Across the collection, Weeratunga combines entertainment with meaningful life lessons, while her interactive approach gives children an opportunity to become participants rather than passive readers.
They can colour illustrations, draw pictures and respond to pages, making each reading experience personal.
That approach also gives the books an added value for parents and educators. They can become conversation starters—helping adults discuss subjects that children may find difficult to raise directly.
For Weeratunga, this is part of the larger purpose of her work.
Her books seek to fill a gap in children’s literature where diverse characters are not simply included for the sake of inclusion, but are given agency, personality and leadership.
In Polly’s Piralympics, disabled characters are not watching from the sidelines. They are the stars.
They lead.
They compete.
They win.
They champion their own adventures.
And that, ultimately, is the brand Weeratunga is building: children’s stories in which every child can find a place, a voice and perhaps even a little courage to become the hero of their own story.
Representation matters.
For young readers in Sri Lanka, Weeratunga’s books are now available through Sarasavi Bookshop, Vijitha Yapa Bookshop, M. D. Gunasena and Expo Graphics, Battaramulla.
Life style
An evening where hearts sang as one
By Zanita Careem
Music, laughter and a generous spirit filled Raflfles Hotel Colombo as Heart to Heart sing along brought together a vibrant gathering for an evening of melody, friendship and giving. The elegant ballroom reverberated with familiar lyrics as guests joined in, sang along and simply let their hair down. Adding to the infections atmosphere was the talented Rajiv and Clan, whose lively performance kept the energy soaring and had the gathering singing to some much loved favourites.
Keeping the evening moving with plenty of wit and warmth was the compere Mirzab Sherifdeen who ensured there was never a dull moment between the music, laughter and spontaneous sing-along moments, Guests were also treated to prizes galore adding an extra element of excitement to an already festive evening. There was cheers as winners stepped forward to collect their prizes, while friends and families aplauded and celebrated every winning moment.
Yet beneath all the sparkle was the meaningful purpose of Heart to Heart Trust Fund, founded by Dr. Rajitha Y de Silva and Dr. Ruwan Ekanayake, bringing people together in support of a cause built on compassion and care.
The dedications and the volunteering was evident throughout the evening with their commitment adding a special warmth to this special event.
Adding to the evening’s indulgence was a sumptous spread of cuisine by the Raffles, Hotel with an enticing selectiom that kept guests happily returning for more. From savoury favourites to tempting desserts, the food complemented the festive mood perfectly.
As the final song faded and the evening drew to a close, there was a quiet sense of gratitude. Behind the music, laughter, prizs and beautiful memories was a cause built as compassion, a cause that has continued to touch lives through the dedication of Dr. Rajitha de Silva and everyone who has stood beside him in the journey of Heart to Heart.
And as guests left Raffles Hotel with the last melodies still lingering in the air the most beautiful note of the evening remained – the sound of hearts earning for hearts. At the very heart of Hearts to Heart is Dr. Rajitha whose compassion has become the soul of the initiative. Dr. Rajitha’s work reminds us that medicine is not only about repairing what is broken. It is about giving people the courage to believe in tomorrow. And perhaps that is the greatest gift he offers. This spirit was beautifully reflected throughout the evening.It was a beautiful evening of music, friendship and generosity, with every contribution going towards a worthy cause- keeping alive a legacy built one one simple but powerful belief that every heart deserves a chance to beat on.
- Ramzi Rahaman with friends and family enjoying an evening of music
- Sarath Wimalaratne, Chandra and Bunny Bohoron
- Brigadier Bohoron
- Shanti Fernando shares a warm and happy moment with volunteers, adding to the camaraderie and cheerful spirit
- Shahana, Sherin and Shahareen
- Lakshmie with her graceful moves
- Onitha Gurugalle with Arujana Ranasinghe
- Cardiologist and Senior Consultant Dr. Ruwan Ekanayake
- Dr. Rajitha Y de Silva and Dr. Arunie
- Former Cricketer with spouse
- A guest takes centre stage
Life style
Taste of Ceylon leaves a lasting flavour
Taste of Ceylon opened its doors at Beira Kitchen, Courtyard by Marriott Colombo, on September 3rd; a festival of Southern, Central, Uva and Northern regional food, brought together on one table.
Four Regions, One Unforgettable Table
Each night, guests moved between four distinct culinary worlds. From the South came the deep, coconut-rich flavours of malu abulthiyal and Negombo pork curry with pineapple, alongside a lively fish polla roti action station. The Central province brought Kandalama lake fish, black octopus curry and carrot kalupol; dishes rooted in the region’s lakes and forests. Uva’s table leaned rustic and warming, with village chicken stew, prawn curry with murunga, and a coconut pittu drawing steady queues. And from the North came bold, unmistakable flavours of Jaffna crab curry, Jaffna mutton curry, and a dosai action station that quickly became one of the evening’s most talked-about corners.
Layered around the four regional stations was a spread that told its own story of Sri Lankan hospitality, from belimal herbal welcome drinks and a bread corner stretching from curry leaves rolls to kurakkan viyana rolls, to a dessert corner where watalappan, wood-apple coconut wandu and king coconut jelly sat alongside a full spread of traditional Sri Lankan sweets like kokis, athirasa and aluwa.
What the guests had to say
The feedback on opening night carried a common thread: guests were struck by just how different each region’s food tasted, side by side, on the same table. What could easily have blurred into “just Sri Lankan food” instead came through as four distinct culinary identities; the fire of the North, the coastal warmth of the South, the earthiness of the Central hills, and the rustic comfort of Uva, each unmistakably its own.
A Word from the team
Reflecting on the festival, the team at Courtyard by Marriott Colombo shared that Taste of Ceylon was designed from the start to be more than a menu. It was meant to be an experience guests could travel through, one region at a time, without leaving Beira Kitchen. Judging by the response over the four nights, that’s exactly how it landed.
There were many rave reviews and as the Taste of Ceylon experience at Beira Lake drew to a close, the flavours, aromas and vibrant spirit of Sri Lanka lingered on.
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