DS was in the perfect position throughout my whole pregnancy and dropped nice and early, head almost on cervix apparently... then he decided he was comfy in there so was induced at 40+11. The little bugger turned back to back specifically for labour 😂😂 and a midwife mentioned it but didn't volunteer any more information than that. It's only since the birth that I've realised it means more painful contractions. And they were horrific, but then he was my first DC so I have nothing to compare it to.
For me it was the fact that the contractions hit me full force with no build up which meant that the gas and air didn't work. Apparently the gas and air works because you start using it as you feel a contraction building so it's got time to build up in your system before the crescendo of the contraction, but mine just came one after the other with no gaps or spaces to breath and the gas and air was useless. Not that I stopped using it, I had it clamped between my teeth the whole time! I also had three failed epidurals and was being monitored so was stuck on my back. The only time I got a bit of relief was when they gave me pethidine. Fucking beautiful stuff. A whole hour of being off my face on drugs instead of off my face on pain.
I did tear, 2nd degree I think.
If you know he is back to back I would say if you can turn him, then great but if not, go in to it knowing all your pain relief options in detail. Actually, do that regardless of whether he is back to back 

It's worth saying as well that although I genuinely thought I was going to die because of the pain, the pushing was actually much less painful in comparison and honest to God the second he was out, the pain was gone.