Bright Lights, Dim Prospects & Daunting News

One of the basics of sleep hygiene is to sleep in a darkened room. Kind of a no-brainer.

However, what is a common reason people wake up in the night? If you’re like me, it’s often to go to the bathroom. Where are the brightest lights in your whole house? Likely the bathroom. Imagine the signal these bright lights are sending to your sleep systems?

Maybe you wake up for some other reason and next thing you know, you’re scrolling on your phone. Many are aware there’s a way to switch it from Light to Dark mode so perhaps the light won’t interfere with you getting back to sleep – too much.

Yet, what is the content you’re reading? Is it news? Social media? Is it something that might alert or arouse your nervous system or thoughts… late at night? Both, seem to have a way to wind things up for many.

These are a few of the things we will be exploring in Rest & Restore: Strategies for Sleep that begins Feb 16th. Each Tuesday night we’ll dig into some of the research around sleep. Then, explore some practices to help calm your sleep systems or change some unsupportive sleep patterns. Add in some quiet time and finally an opportunity to ask questions, connect with others should that be of interest you.

Though the sessions will be on Zoom, if you’re not a Zoom user or are experiencing Zoom fatigue, everything will be available for you to view on your own schedule, at your own convenience on the Teach:able platform.

Just, Calm Down

It was probably my first year as a yoga teacher, 10 years ago now, when I had a student in my class I so clearly recall would get up and leave as soon as it was time for Savasana. I’ve been trying to remember what I offered her in terms of advice but it escapes me now. Likely, I didn’t have much to offer. Yet I did empathize and understand why she left, unable to stay in this ‘corpse pose’ as it’s often called.

Ask the same of people when they are told to “just” sit still and meditate. Particularly if they’re experiencing anxiety, or high levels of stress and notice what happens.

Or telling a young child having a full-blown meltdown to “just” calm down.

The last thing anyone can do in these moments is calm down. There are likely to be many reasons for the state in which people find themselves and can’t calm themselves, but the ‘state’ is the important piece.

If someone is in a state of arousal, a natural nervous system response, telling them to do the opposite may not be helpful. It might add to the stress or leave them feeling ashamed about not being able to control their emotions or behavior. All this movement, powerful breathwork (sobbing), yelling, screaming, stomping of feet, tossing and turning the body in an attempt to express feelings and emotions going on inside (insert here: toddler meltdown).

There are some ways, practices or movements that enable calming down or a relaxation response. But it might be something just the opposite that’s needed to even begin this shift. Maybe what was needed, in this particular situation, is a mobilized response. We need both… to survive and engage in the wide variety of experience life is going to throw our way.

Recognizing the state is the first piece. Having some tools and options to choose from that might be helpful to you in the moment, could be a good thing to practice.

Today, I would have a few suggestions should this person turn up in my yoga class and find it a struggle being in corpse pose.

I’m kicking off a workshop in February all about SLEEP. Deep rest. How one might get to a place of settling in… for the night. Or for Savasana. Or if you’re having a hard time with routine, uncertainty, stress in these days you might find it helpful as well. I’d love for you to join in so stay tuned here, or you can sign up at yogatoolsforlife.com.

Pay attention, to what?

Let’s look at a couple more practices you might consider to use in the evening. And why.

If you’re ever in a class or a private session with me you will hear me speak about the brain and the nervous system. Which might be unusual, when thinking about pain. Normally people will talk about tissue, bones, structure. Research over the last 10-20 years tells us pain is much more complex than the state of these ‘pieces of your body’.

Your brain, which kinda runs the show in terms of keeping you alive, is all about your survival. Which is a good thing. The problem is, it tells us something is up but it doesn’t always provide specifics or what we might do about sensation or messages we receive.

Whether physical health or mental health, however, your brain is looking out for your best interests. Which is why when you can’t seem to take your attention away from your pain, suffering, concerning thoughts or stressors, it makes sense when you think about it. It is drawing your attention, purposely to these things. It wants you to act in some way. To do something.

Sometimes, you might know what to do and choose to take action. It’s obvious. If you pick up a hot pan without gloves, your brain is saying you should have put potholders on prior to doing so. If you have a broken ankle, it is telling you to seek treatment and take some time to allow for healing. If you need to have a difficult conversation with someone, your brain – and subsequently your physiology – will send some kind of signal. You might feel motivated, mobilized, prepared and confident. Or you might feel anxious, butterflies in the stomach, strain in your jaw, neck or shoulders. In each, you receive information about your state of being concerning what is about to happen or what has occurred.

The number one thing pain or any other sensation you might feel in your body is trying to do, is to get you to listen. To get you to pay attention.

Usually working in the background without any of your awareness at all, the brain is constantly monitoring your physiology and making adjustments accordingly as required. It’s releasing hormones, sending messages to move certain muscles, signals that tell you when to eat, or sleep. It adjusts your blood pressure, regulates your temperature. Creates enzymes to digest your food. Tells you when to poop. Well, it does right?

The thing about pain, however, is it’s sending a message but often you can’t figure out what’s up. What you’re supposed to do. It’s hard, it takes time to figure it out. To explore what’s needed or right for you.

But back to this paying attention. What can you do when you’re in the thick of it? Particularly when you’re trying to sleep at night (and let me just add that the correlation between sleep and pain is huge).

How might you distract your brain, how might you shift your focus onto something else? At least for the time being. Well, there is a longer explanation that involves the Homunculus Man (above picture) but I won’t delve into it too much here. Rather, offer a couple practices you might like to try.

This, using the sounds SaTaNaMa was taught to me a couple years ago and it combines the rhythmic movement of your breath with the rhythmic movements of your jaw and fingers and rhythmic sounds. You can check it out here. I’ve had clients tell me it can be quite helpful when they are really in the thick of a painful experience/episode, flare-up. Or if you wake up in the night and immediately feel pain.

You might practice something like nadi shodhana, or alternate nostril breathing, for 5-10 minutes before bed. You can practice it sitting up if preferred but you might also do so when laying in bed (or if you wake in the night), using your fingers to close the nostrils. This practice also engages the hands, breath, the face (nose).

All these areas send a lot of sensory information to the brain. Your senses are used to take in information, that helps with your survival. Think about noxious toxins you might smell, seeing danger, touching something dangerous, your sense of taste in terms of toxins or allergens particular to you, hearing a predator in the distance. The brain pays particular attention to these areas so if you can engage the brain, have it pay attention to a ‘safe’ activity it might, just might, change your pain. Allow for some calming, easier breathing. Switch from a danger, or mobilized state in your nervous system to a more safe, restful place.

Or maybe you use one of the Apps available like Calm or Insight Timer that grabs your brain’s attention. Listen to some calming, soothing music. Or perhaps use the smell of an essential oil that for you, might trigger a response that it’s time to sleep and safe to do so.

Let me know if you give any of these a try and how it goes. I hope you find them useful in some way.

Balancing Act

In preparation for sleep at the end of your day, it might be another time to check in with how you’re feeling.

You might feel fully exhausted, in which case you may have an easier time falling asleep. Yet, even if you’re physically exhausted there is also a possibility of being in a mobilized, or upregulated state in your nervous system.

  • You may have been going full speed ahead with what feels like a million things required of you on any given day. Trying to balance what seems like never-ending demands.
  • Maybe you’ve just had an emotional or stress-filled conversation with someone.
  • You might be feeling some of the long-term stress from these strange times of Covid-19.
  • Maybe you ate a big meal late in the evening as you didn’t had time to do so, earlier.

Your body, your physiology, automatically changes and/or responds to what is going on, what is required in a given moment of time. First of all it takes some awareness to even notice what the state of being, or the state of your nervous system, is. If you’re in fight, flight or freeze (a more sympathetic nervous system response) sleep might not come so easily. However, if you can learn to shift into a more parasympathetic type response (the rest and digest response) it might make the transition to sleep more easeful.

The first step is in the noticing.

Perhaps you can do a body scan to notice what you feel. Bringing your awareness slowly to each part of your body, noticing any sensation you feel or any thoughts or feelings that arise as you do this. Or you may come to know through noticing the quality of your breath. Or perhaps noticing your thoughts and emotions.

People often have difficult going to sleep. More so these days, I find. You might want to look at it, approach it, in a way that requires some preparation. We need both types of nervous systems responses. We have stresses in our life, we need to mobilize. Yet, how might we find some balance and what practices might be helpful in the evening to downregulate our system. To allow for rest and build capacity to meet the challenges of our days. What might make the transition, more easeful? We’ll dig into a few this week.

Preparing for Slumber

Depending on where you are in the world and your environment, you may notice some changes taking place. A change of season. It is quite obvious where I live as the foliage, the trees and the grasses are all preparing for winter. Transitioning to a new phase. Not only the beauty you can see here but the seasons also provide a steady rhythm to life. Continuity.

When menopause struck and I was suddenly experiencing disrupted sleeps, yet another transition. A new season. I couldn’t help but recall another stage of life gone by, the early days of parenthood. Those feelings of being absolutely depleted, exhausted. I can only surmise my dreary eyes gazing upon those loving baby faces helped get me through it.

I distinctly remember every time we got in the car to go somewhere, babies safely tucked into their car seats, I immediately fell asleep. Why was that?

I was exhausted.

I knew our babies were safe. I had some time and space when I no longer had to be vigilant, listening and watching over them.

The subtle swaying motion along with the soft hum of the car as my husband drove provided some cues, a stimulus that helped me drift off to slumber.

What were some of the things you did to help get your babies to sleep? I can recall softly stroking their head, their face, “tickling” as we called it. Soothing, rhythmic music playing in the background. There were at times suggestions made to put them on top of the dryer or something similar (maybe for the same hum, swaying that the car provided me). Wrapping them tightly in my arms. Bouncing, swaying, rocking.

We used another strategy when our twins were babies. During the day, we kept them downstairs in the living room, using one of those portable beds so they could get used to sleeping amidst the goings on of our daily life. But at night we took them up to their cribs, to a quiet, darkened room. A different signal that it was now night-time, different than their brief naps during the day.

We can use strategies, we can develop habits and routines to help create conditions for sleep. These are some of the things often discussed in terms of general sleep hygiene. Learning more about our circadian system or rhythm can also be helpful.

What what else might be useful if we’re having trouble with sleep?

Well, there is evidence to show how stress can affect our physiology and our sleep. And, I can imagine many are feeling the effects of stress these days. This hyperarousal, or perhaps it is more like hypo-arousal these days.

How does stress show up in the body? What happens? What are the changes that take place? Can we change or influence our nervous system’s response to stress?

Navigating transitional moments of life is a challenge. Often, there is a letting go required and a stepping into the unknown. Uncertainty. There may be feelings of loss, grief, sadness. Maybe there is anger or resentment or … well there are likely to be many feelings. Including love, beauty and joy. Maybe freedom. All showing up, moving, shifting like a roller coaster ride. Felt and experienced in the body.

Perhaps exploring this a little, what we notice, the sensations that rise and fall throughout the day (and night) might be useful. Making sense of it. Accepting these moments with some kindness and compassion, moving through them with awareness, finding some ground when we need it most. A way to settle into slumber when night falls.

Curious?

I’m planning to offer an online program where we can explore this both through some gentle movement practices, journaling or other written work, information, breath and awareness practices. If this is of interest to you please let me know, send me a message, comment below, sign up to the site or email me at info@yogatoolsforlife.com. There’s no commitment from you required, I’m only gauging if there is interest at this point.

Take care.

 

Pain is weird and it can change

Do you know that you can experience a HUGE amount of pain, yet have no damage or injury in your body?

Have you ever heard of phantom limb pain? It’s when someone experiences pain, yet they don’t even have the body part? Think of someone who’s maybe had their arm amputated but still feels pain there. How can that be?

Or maybe you’re someone who has been diagnosed with fibromyalgia. No obvious damage or injury can be found yet absolutely, you feel pain.

Do you know the reverse is also true? You can have NO pain and yet have ‘damage or injury’ in your body?

Have you ever found a bruise on your body yet had no idea how it got there? Or maybe you broke a bone playing one of your favorite sports but didn’t really feel pain, until you got to the hospital? There was obviously tissue damage, yet no pain. At least at first, perhaps.

Maybe you’re someone who has disk degeneration, yet no pain. According to this study (brinjikji et al 2014) if you’re 60 years old, 88% of people whose back has been imaged will show disk degeneration, yet experience NO pain.  If you’re up to 70 years of age, it’s up to 95% who have what looks like damage or injury and yet has NO pain.

When you have a headache, think of a really, really painful headache, … do you think you have something broken or damaged in your head?  Likely not.

So why do we think that way about other parts of our body?

Pain is weird, for sure. And complex. And our understanding of it does not always match with what’s going on. Often, we are confused by it, don’t know what to do about it and just live with it.

Don’t get me wrong. You NEED pain. Otherwise you would likely not survive. You need a mechanism to tell you something is up and you need to attend to it.  

It’s the persistent chronic pain that seems to be the trouble. In Canada and most places around the world, 1 in 5 people live with it. If it were an easy fix, we would have done so by now. Two areas that the evidence tells us seem to be most helpful are: understanding pain and movement. We’ll cover both.

Well, there is more to it but if you’re curious to know how you might change, how you can influence your own experience of pain, I’d love you to join a new 6-week online program starting July 22, 2020.

Advantages of this being online?

  • anyone can take it in the privacy of their own home,
  • at their own pace
  • all the content is yours to keep forever, and
  • I’ve made it affordable and accessible so anyone can enroll. $25 week, for 6 weeks (both a payment plan and options are available).

 If you or someone you know might benefit, click the link below for all the details.

Or you can always contact me here, to ask any questions.

What do you do, in yoga classes for people living with chronic pain?

one thingThe second question people often ask me about Pain Care Yoga classes, after “who is it that comes to these classes” described here, is “what do you do in them”?

Pain is never just about one thing. You want to know what’s wrong. How you’re going to fix it. And how long it’s going to take. And rightly so, as having long-term pain often changes everything for you and how you live your life.

When it comes to pain, however, it is usually not that simple which is why searching for ‘the thing‘ usually doesn’t work in the long-term. Particularly if you’ve had pain for a long time. Which doesn’t mean to say that it can’t change. It can. We know what can help to bring about change, the best practices research points to.

Two key aspects, education … and movement, are important. So that’s what we do in these classes.

EDUCATION

Some kind of education piece, usually at the start of the class, is provided. I only spend a few minutes on this, but it’s important to do so. One of the most common things I see with people in pain is the fear of moving. If I can help you to understand why it might be safe to move and why it’s important to do so, that’s a good place to begin.

“Current evidence supports the use of pain neuroscience education (PNE) for chronic musculoskeletal (MSK) disorders in reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization.” [1]

PRACTICE

Then, you practice. You get to experience how you might move, with guidance and guidelines, to learn what’s right for you. Which often won’t be the same as others in the room.

Movement

This is not a typical yoga class with sun salutations, downward dogs, lunges, forward folds, backbends. It is not even what I would call a ‘gentle yoga class’. Yes, we use slow, gentle movements. Yet, sometimes you might begin by just imagining the movement if you don’t yet feel safe to do it. Or you might practice it in your mind, plan out how you might go about it and if it feels right for you. It is always your choice to do or not do anything presented in class. You always get to decide how to move, how far to move, by using a slow, mindful exploration along with guidelines and principles utilized.

Most movements are fairly simple and modifications are always available. You’ll experience a lot of repetition, and rhythmic movements. Movements that cross the midline of the body. Movements that challenge your brain as well as challenging your body.  You, anyone, can really begin wherever you’re at. With what’s right for you.

Breath

There will always be some kind of breathwork or a breath awareness piece in the practice. Again, it’s not so much about controlling the breath, rather what you might notice about your breath. How breath can be an indicator of your physical and emotional state at any given time. Also, learning how breath can help to bring about change to your nervous system, physiology, which can then change your experience of pain.

Awareness

Like breath, awareness is key. So often when you are in pain the last thing you want to do is pay more attention to your body. But in fact, this paying attention is your guide to changing pain. It is in this noticing that you can begin to explore what the signals (or sensations) you feel might be indicating, what might be your unique contributors to pain, what might be the reasons for flare-ups. This practice is not only about noticing your body in class but then also paying attention to your whole self in your environment, in the larger world you live in.

Relaxation

There are many reasons, purposes and benefits to practice relaxation techniques. In most yoga classes this is done at the end of class. Though we’ll also do some kind of formal relaxation practice at the end, relaxation or creating a state of calm is facilitated right from the start.

It is when you are in a place of safety, when you are calm and relaxed, that change is likely to occur. It is this place of calm (a parasympathetic state) when you might first experience a change in your pain. Without this, it’s no different than trying to stretch, exercise, push through and strengthen your pain away, which seems not to work out so well.

If you’re interested in learning more, have any questions or would like to sign up for the next series of classes starting at the end of February, please get in touch here. I’d love for you to experience, how you might learn to change your pain.  Or, if you prefer a one-to-one session, information can be found here.

[1] Adriaan Louw, Kory Zimney, Emilio J. Puentedura & Ina Diener (2016) The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature, Physiotherapy Theory and Practice, 32:5, 332-355, DOI: 10.1080/09593985.2016.1194646

 

Taming the Beast, that is pain

Professor Lorimer Moseley explains how pain scientists are making amazing discoveries that can help you understand your pain, the first step in taming the beast.

As you’ll see, pain always involves the nervous system and how your nervous system can be retrained.

  • “How do you know if your pain system is being overprotective?”
  • “How do you retrain your pain system to be less protective?”
  • “How do you know if you’re safe to move?”

Learning a little about pain neuroscience education can be helpful. [1]

What complements this is not only learning but experiencing how YOU can change or modulate your nervous system.

Use the tools yoga has to offer; gentle movement, breath and awareness practices… to soothe and calm the system. To ‘Tame the Beast’.

You can find more information and resources at TameTheBeast.org.

[1] Louw, Adriaan & Zimney, Kory & Puentedura, Emilio & Diener, Ina. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice. 32. 1-24. 10.1080/09593985.2016.1194646.

Low Back Pain – What works and what doesn’t, according to the research.

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Previously I wrote about the first in a series of published papers in the Lancet regarding the global burden of disability caused by low back pain and why we need to pay attention. You can read it here.

The second paper, “Prevention and treatment of low back pain: evidence, challenges and promising directions” contains a lot of information so today I’ll begin with prevention and treatment while the next blog post will further explore current guidelines vs. what’s actually utilized in the global medical community.

My hope is perhaps you’ll come to see for yourself there are promising directions for those disabled and suffering from low back pain.

I. Prevention

Most of the widely promoted interventions to prevent low back pain do NOT have a firm evidence base.

A surprising statement, isn’t it? These include what you have likely been told over and over again to do, yet evidence of their success is not there. Strategies about workplace education, no-lift policies, ergonomic furniture, mattresses, back belts, lifting devices. How often have you heard about most or many of these in terms of how we might prevent low back pain?

What then, seems to work?

II. Treatments

First, is the recommended use of a biopsychosocial model.

I suggest most of the general public has never heard of this term or model of care. I surely didn’t just a couple years ago when I was first started to dig into the overarching problem of chronic or persistent pain that affects so many people.

What is this? Well, as often defined it encompasses “a dynamic interaction among and within the biological, psychological, and social factors unique to each individual.”  My emphasis on the ‘unique to each individual’, as that’s turning out to be an important piece of the complexity of pain.

Second, greater emphasis is needed on

  • Self-management
  • Physical and psychological therapies
  • Some forms of complementary medicine,

Along with less emphasis on

  • Pharmacological and surgical treatments.

What’s actually being utilized in our clinics?

Surprisingly, the treatments with less emphasis and effectiveness = pharmacological and surgical treatments.

Countries such as Denmark, the USA, and the UK do have guidelines around this. They are supposed to utilize exercise and a range of other nonpharmacological therapies such as massage, acupuncture, spinal manipulation, Tai Chi, and yoga.

Clinicians are meant to provide people with

  1. Advice and education about the nature of their pain;
  2. Reassurance that they do NOT have a serious disease and their symptoms will improve over time;
  3. Encouragement to stay active and continue with usual activities.

Self-Management

I understand even the notion of engaging in movement and exercise is difficult for people who are experiencing pain. How do you keep active when you are in pain? How much does advice, education, reassurance really help? People typically go to their health care providers and want something to ‘fix’ the problem. Not more advice. However, evidence shows this does help. And, evidence shows that the pharmaceuticals and surgeries we’ve come to rely on, don’t. In the long-term, particularly. If they worked, we wouldn’t find ourselves in this predicament.  Understanding that you have a part to play, in getting better, is critical. 

Movement or Exercise Therapy

Going back to the problem of trying to move, when you’re in pain. Something that people may or may not be familiar with is the term graded exposure. Basically, it means you start where you can, and gradually, over time, work to increase your overall capacity.

I tell my clients it will help to do even the smallest of movements. Use your imagination and even just visualize movement if you must, but you CAN start somewhere. Move your feet, or hands, or arms an inch, if that’s what you can do today. Just begin.

It has been shown to be useful if you can tie in your exercise or movement with something you want or need to do, rather than just some kind of exercise that is not motivational for you.

It’s not really so much WHAT you do, but that you DO something.

“Since evidence showing that one form of exercise is better than another is NOT available, guidelines recommend programmes that take individual needs, references, and capabilities into account in deciding about the type of exercise.

I use tools that yoga offers and work to help keep clients joints moving in all the many ranges of motion they might need in their life. This does not mean they need to have a life-long love or commitment to yoga.

Yet, yoga does offer an important first step of building awareness and subsequently using gentle movement, breath awareness, and tools to ‘ease into a movement’ that may have be feared in the past. People can learn to calm their nervous system, work in a safe pain-free range of motion (or not increase pain). From there we work to build stability strength and power in whatever it is they want to do … be that swimming, walking, biking, skiing, playing with kids, sitting at a desk all day. Whatever it is they want to do in their life.

Passive Therapies

It should be noted that some guidelines DO NOT recommend passive therapies, such as manipulation or mobilization (think chiropractor, massage, acupuncture). Some guidelines consider these short-term options, optional. The same goes for other passive treatments received in a physical therapists office like ultrasound, nerve stimulation, etc.

Though these passive types of therapy may help to temporarily feel better, they often have many returning again and again, becoming dependent on them for relief. Much of the current research shows the need to get a person ‘involved’ in the treatment. Get their brain and nervous system participating in movements or other practices, so passively ‘being worked on’ might not be a long-term solution.

Psychological Therapy

Guidelines also recommend Cognitive Behavioral Therapy (CBT), progressive relaxation and mindfulness-based stress reduction (MBSR).

This again is where yoga can play a part in terms of relaxation. I’ll often incorporate strategies from MBSR when working with clients.

Pharmacological Treatment

Guidelines now recommend pharmacological treatment ONLY following an inadequate response to (the above mentioned) first line non-pharmacological interventions.

Paracetamol was once the recommended first-line medicine for low back pain; however evidence of absence of effectiveness in acute low back pain and potential for harm has led to recommendations against its use.

Health professionals are guided to consider oral non-steroidal anti-inflammatory drugs (NSAIDS), taking into account risks …  and if using, to prescribe the lowest effective dose for the shortest possible time.

Routine use of opioids is NOT recommended, since benefits are small and substantial risks exists…

The role of gabaergic drugs, such as pregabaline, is now being reconsidered after a 2017 trial showed it to be ineffective for radicular pain … guidelines generally suggest consideration of muscle relaxants for short-term use, although further research is recommended.

Surgery

The role of interventional therapies and surgery is LIMITED and recommendations in clinical guidelines vary.

Recent guidelines DO NOT recommend spinal epidural injections or facet joint injections for low back pain… they DO NOT seem to provide long-term benefits or reduce the long-term risk of surgery and have been associated with serious adverse events.

Benefits of spinal fusion surgery … are similar to those of intensive multidisciplinary rehabilitation and only modestly greater than non-surgical management.

UK guidelines recommend that patients are not offered disc replacement or spinal fusion surgery for low back pain.

For spinal stenosis … patients tend to improve with or without surgery and therefore non-surgical management is an appropriate option for patients who wish to defer or avoid surgery.

So why the GAP between evidence and practice?

Stay tuned and we’ll look to see how this is played out and why it’s imperative that we change it.

 

 

 

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

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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.