Low Back Pain – Extremely common, complex in nature and most often, not treated effectively

ape

Last week I wrote briefly about a recently published paper in the Lancet, picked up by the news in the UK, here, here, here, and here. Today, I’ve seen an article in the USA. So, far, one report that I can find, in Canadian news.  One headline from Monash University in Australia goes so far to say:

Global burden of low back pain – a consequence of medical negligence and misinformation

As mentioned, I said I would break down why I believe this is so important. The first paper (three in the series) is “What low back pain is and why we need to pay attention”.

Why should all of this matter to you? Why do you need to pay attention?

The median 1-year period prevalence globally in the adult population is around 37%, so chances are you or someone you know is affected.

And, what’s even more important, is

the way we have been treating people isn’t working.

“Low back pain (LBP) is now the number one cause of disability globally.”

There are a LOT of people who experience chronic or persistent low back pain.  On a purely personal note, I would say it is the most prevalent ‘problem’ people tell me about when they turn up at my yoga classes.

“Rarely can a specific cause of low back pain be identified; thus, most low back pain is termed non-specific. Low back pain is characterized by a range of biophysical, psychological, and social dimensions that impair function, societal participation, and personal financial prosperity.”

In other words, it’s complex.

Of course, there is always a need to rule out those cases where there is specific causes.

“but, this is for less than 1% of those presenting with LBP. Known causes may include vertebral fracture, axial spondyloarthritis, malignancy, infection, or cauda equine syndrome (very rare).”

So if any of these are suspected by presenting symptoms, a clinician is well advised to do testing, imaging, etc. for what are often referred to as ‘red flags’.

If these are ruled out or if you’re not suspect for these specific causes, what then?

“Most adults will have low back pain at some point.  It peaks in mid-life and is more common in women, than in men.”

“Low back pain that is accompanied by activity limitation increases with age.”

“Most episodes of low back pain are short-lasting with little or no consequence…”

“But recurrent episodes are common and low back pain is increasingly understood as a long-lasting condition with a variable course rather than episodes of unrelated occurrences.”

It’s highest in working age groups so the effect to the workforce is impacted. People unable to work, earn income, the possibility of early retirement. “In the USA, LBP accounts for more lost workdays than any other occupational musculoskeletal condition”.

Then there’s a person’s identity. Consequences such as loss of independence, ability to fulfill expected social roles can be impacted. Common themes of worry and fear are identified, along with hopelessness, the strain on families, social withdrawal, job loss, and there’s the navigating through continual healthcare encounters.

Most studies underestimate the total costs of LBP, but the economic impact is comparable to other high-cost conditions like cardiovascular disease, cancer, mental health and autoimmune diseases.

Most cases are resolved within 6 weeks, however, there are risk factors for recurring episodes. For people with other chronic conditions like asthma, headaches, diabetes. Those with poor mental health are at increased risk, etc. As one example, a study of Canada’s population with 9909 participants, found that “pain-free individuals with depression were more likely to develop LBP within 2 years than were those people without depression”.

Lifestyle factors are also at play. Smoking, obesity and low levels of physical activity are associated, although independent associations remain uncertain.

Which brings us back to it being complex. There are multiple contributors, “including psychological factors, social, biophysical, comorbidities and pain processing mechanisms.”

We can see the complexity when there is a continual increase of those affected, an increase in our health care expenditures and by the recent opioid crisis that is literally taking people’s lives.

It also seems whatever we’ve been doing in terms of treatment doesn’t seem to be working.

Why is that and what needs to be changed?

Tune in next week… where we’ll get to the second paper, “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”

Note:   For those interested, all references/studies can be found in the Lancet paper, here.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s