Back Pain – There is Good News

The bad news is you may have or know someone that is experiencing chronic or persistent back pain. The good news is, there is a way forward.

Yesterday, three important papers about back pain published in the Lancet (one of the world’s oldest and best known general medical journals) were referenced in the The Guardian, The Telegraph, the BBC News and the Daily Mail . So current evidence-based information, at last, making its way to the public domain.

In briefly reviewing the papers (published March 21, 2018), the key points for me are these:

“Low back pain is now the leading cause of disability worldwide.

“Prevention of the onset and persistence of disability associated with low back pain requires recognition that the disability is inseparable from the social and economic context of people’s lives and is entwined with personal and cultural beliefs about back pain.”

“Most low back pain is unrelated to specific identifiable spinal abnormalities,”

“Globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences.”

“Recommendations include use of a biopsychosocial framework to guide management with initial nonpharmacological treatment, including education that supports self-management and resumption of normal activities and exercise,…”

Thank goodness this is getting the attention it deserves so it can help people who need it most. And that’s a LOT OF PEOPLE.

Why now, finally? I think it’s gaining traction due to spiraling health care costs along with the opioid crisis that is so prevalent.

Over the next while I’m going to break down and comment upon some of the points and principles presented in the papers, as many form the basis of my work.  In the meantime, if you care to read the papers yourself they can be found here.

Lorimer Moseley, one of the world’s top researchers on pain continues to make the related point that people need an understanding of what pain is and what it isn’t, as he does with a touch of humor in his TEDx Talk in 2011.  Professor Moseley is most known, however, for publishing 260+ papers on pain science and his continued work as Professor of Clinical Neurosciences and Chair of Physiotherapy at the University of South Australia. And one of many leading the charge globally in what he calls a Pain Revolution.

A huge paradigm shift is required as understandably, information about what works to treat back pain and what doesn’t is confusing.  It seems counter-intuitive to ask people who are in pain to ‘just move more”. As the latest interviews I’ve listened in to with Lorimer, he states that with what we’ve learned ‘recovery is, back on the table’.  There is hope. As I mentioned earlier, there is a way forward.

I talk about this all the time with family and friends … who often have a hard time believing what I describe as it is a change from what we have believed for most of our lifetime. 

But, if we really truly want to get people out of this pain cycle (and I will say most any pain cycle) we need to help with the understanding of what the evidence shows and how to best work with it. This will also require huge shifts in our public policy, etc. as stated in the Lancet papers.

“These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.”

So come along for the ride if you or anyone you know is experiencing chronic or persistent low back pain (or any pain, really).  With 1 in 5 experiencing chronic pain of some kind, unfortunately, you won’t have to look too far.