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What is Low Back Pain and What Can We Do About It?

Published: 7th Jun 2018   



A series of scientific papers on low back pain were recently published in the Lancet Medical Journal. The papers were written by a team of international experts and caused a lot of interest among the medical and rehabilitation media outlets. The papers explained what back pain is and defined how big a problem it poses world-wide. Evidence for how back pain should be treated was presented and some existing management strategies were criticised. This ruffled a few feathers up the medical tree and put back pain into the media spotlight for a day or two.

The three published papers inform that back pain is the number one cause of world-wide disability and occurs in people of all ages from children to pensioners in all countries. The number of back pain sufferers has been recorded at a staggering 540 million people at any one time worldwide (numbers have increased considerably in the past 30 years and are predicted to rise further). In the UK back pain is the most common reason for visiting a G.P. and represents 39% of all A&E attendances. The impact of an episode is greater in people of working age but fortunately most cases are short lived with little or even no consequence. However, it is frequently recurrent and some cases are more complicated presenting a more variable and longer lasting course with more serious implications.

The authors stress that the spine is complex with many different structures capable of causing pain, including even social and psychological reasons. Despite all the advances in science and modern medicine for most low back pain cases it is not possible to identify the specific structural cause of the pain. This frequently leads to a medical diagnosis of Non-Specific Low Back Pain and represents the majority of cases. Persistent low back pain may need a careful assessment to rule out more serious medical conditions but these are rare.

Frustratingly pain does not show up on an X-Ray or MRI scan and changes found in people with back pain are also found in people without pain, making the usefulness of imaging techniques limited and their use in making a diagnosis questionable. Guidelines state that imaging should not form part of the early management for back pain in the absence of signs of more serious medical reasons.

Research indicates that lifestyle and health factors such as; smoking, obesity, diabetes, depression and inactivity are associated with higher rates of back pain. Interestingly, back pain is regarded as a symptom and not a disease. It can be associated with leg pain, which if traveling below the knee, is known as radicular pain. This implies that a nerve root is involved and termed Sciatica, often incorrectly labelled as a trapped nerve and can be severe in nature. People with sciatica are reported to suffer more severely than people with back pain only. Disc injuries and the associated inflammation is the most common cause and are likely to be more longer lasting.

Statistics show that most cases of low back pain improve substantially in 6 weeks but two-thirds of people still report some pain at 3 months and 33% will suffer a recurrence. National clinical practice guidelines place a greater emphasis on self-management with the help of physiotherapy and less emphasis on drugs and surgical treatments. Active treatments that focus on improving physical function are recommended. Massage, hands on therapy, therapeutic exercise, acupuncture, Yoga, Pilates and Tai Chi have all been endorsed alone or in combination in one guideline or another. Therapy and exercise plans should be tailored to individual needs, preferences and capabilities, i.e. tailor made for you!

The role of more invasive therapies and surgical procedures is now considered limited and to provide little benefit above rehabilitation alone. Spinal injections have been shown to provide only short-term relief and are not recommended for pain other than persistent radicular symptoms. Surgery is very expensive and carries a higher risk of adverse events than non-surgical management, with no benefit above intensive rehabilitation. Therefore, it should be reserved for cases of radicular pain that do not respond to rehabilitation.

The key message is that back pain is mostly not a serious disease and will improve in time. Guidelines encourage staying active, avoiding bed rest and resuming usual activities, including work, as fast as possible. The evidence to date shows that the greatest potential for improving outcomes in low back pain are those treatments which reduce the focus on spinal abnormalities and promote activity. A therapy approach that supports self-management and promotes physical health while avoiding useless and harmful treatments is likely to offer the best value and highest benefit. Active strategies to reduce disability and promote meaningful effective lives are the most likely to deliver positive health changes and the best outcomes in low back pain.

So if you have low back pain think Physio First. You can contact us or email me direct at paul.new@newphysio.co.uk if you would like to discuss a plan for a problematic back

References:
[1] Hartvigsen, et al. (2018). What is low back pain & why we need to pay attention. Paper 1. Lancet. http://dx.doi.org/10.1016/So140-6736(18)30480-x

[2] Foster, et al. Prevention & treatment of low back pain: evidence, challenges & promising directions. Paper 2. Lancet. http://dx.doi.org/10.1016/So140-6736(18)30489-6

[3] Buchbinder, et al. (2018). Low back pain: a call to action. Paper 3. Lancet. http://dx.doi.org/10.1016/50140-6736(18)30488-4

  


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