Again, this is not to say you should be doing “ALL OF THE THINGS”. Particularly as some of THE THINGSlikely won’t resonate or feel right for you in your life as it is today. We all have different lives, environments, needs, bodies, histories.
Which is why getting curious and exploratory can be useful rather than having someone tell you this is THE THING that will work for you. In my experience, if THE THING worked for everyone we wouldn’t have 1 in 4 people living with chronic pain, or so many other conditions or concerns. What if you’re told ‘just do this’ and it doesn’t work? Maybe you end up feeling like you failed in some way (once again), rather than perhaps it wasn’t what was right for you.
If you’d like the opportunity to work with me, I currently offer private 1:1 sessions. Stay tuned for new offerings coming your way in the New Year! Sign up on the yogatoolsforlife website, or follow along on Facebook or Instagram.
These dinner rolls I made to accompany a warming pot of stew on Friday night, were not too bad. Though it wasn’t my first time making them. I recall the first attempt, some 25 years ago. Not. So. Good.
I had to practice a little. Take some time to get a feel for the dough, figure out how to make rolls, the many pieces of the task at hand.
While working with someone 1:1 in a private session, we usually meet every week or two. The reason being is after an assessment, clarifying of goals or focus, whatever we decide to use in terms of practice… is meant to be, well, practiced. For a while. Noticing any effects.
If you’ve been following along with the morning practices over the last week or so, I’m going to pause and allow space for that. You might go back through the various options. There may be some you are already exploring, using. They are not meant to be ‘the thing’ but rather to be used as an exploration. An inquiry as to what you notice, what feels useful. What does not. If you want to go back and review, the posts are noted below:
Nov 3 – Here I am, again
Nov 4 – Softening
Nov 5 – To breathe
Nov 6 – Pause, notice
Nov 9 – Ease, into morning
Nov 10 – Sense making
Nov 11 – Warming up
You might benefit from some included here or what feels right for you might be something altogether different. These are a few suggestions.
We’ll pick this up again on Nov 23rd looking at various practices you might choose to do during the day. Then again, we’ll pause for a week before moving on to evening practices starting on Dec 7th. I hope you’ll stay tuned. Let me know If you have any noticings, feedback or questions along the way.
If this is something you’d like to explore with me privately, I currently offer 1:1 sessions via Zoom. Information can be found here.
Continuing with the second of three papers recently published in The Lancet regarding Low Back Pain. What guidelines are already in place, what’s actually occurring in practice and suggested solutions going forward.
What’s striking to me is the
clear evidence of substantial gaps between evidence and practice, that are pervasive
A few years after delving into this, I am still scratching my head how far behind we are in our medical and clinical practice given the evidence. Yet, I’m hopeful that as more and more of this gets into the public domain, much-needed momentum will begin to close the GAP. Particularly with the crisis we find ourselves in, the growing epidemic of opioid use which is literally, killing people.
What are the treatment guideline GAPS, as outlined in the paper?
study results of clinical practice and highlights the disparity between ten guideline recommendations and the reality of current health care.
Guideline Message: Low back pain should be managed in primary care.
Practice: in high-income, low-income, and middle-income settings, people with low back pain present to emergency departments or to a medical specialist.
Guideline Message: Provide education and advice.
Practice: in high-income, low-income, and middle-income settings this aspect of care is rarely provided.
Guideline Message: Remain active and stay at work.
Practice: in high-income, low-income, and middle-income settings, many clinicians and patients advocate rest and absence from work.
Guideline message: imaging should only occur if the clinician suspects a specific condition that would require different management to non-specific low back pain.
Practice: although such specific causes of low back pain are rare, in high-income, low-income, and middle-income settings, imaging rates are high.
Guideline message: first choice of therapy should be non-pharmacological.
Practice: surveys of care show that this approach is usually not followed.
Guideline message: most guidelines advise against electrical physical modalities (eg, short-wave diathermy, traction).
Practice: worldwide these ineffective treatments are still used by the professionals who administer physical therapies.
Guideline message: due to unclear evidence of efficacy and concerns of harm, the use of opioid analgesic medicines is now discouraged.
Practice: these medicines have been overused in some, but not all, high-income countries; low-income and middle-income countries seem to have very low rates of use.
Guideline message: interventional procedures and surgery have a very limited role, if any, in the management of low back pain.
Practice: these approaches are widely used in high-income countries, little evidence on their use is available for low-income and middle-income settings.
Guideline message: exercise is recommended for chronic low back pain.
Practice: clinician treatment preferences and health-care constraints limit uptake.
Guideline message: a biopsychosocial framework should guide management of low back pain.
Practice: the psychosocial aspects of low back pain are poorly managed in high-income, low-income, and middle-income settings.
As you can see, what’s recommended is not what’s being offered to people for treatment.
Though first line care is meant to be non-pharmacological,
a study from the USA showed that only about half of people with chronic low back pain are prescribed exercise. In Australian primary care and in the emergency department setting in Canada, the most common treatment is prescribed medication.
Then, there are the rates of imaging, even though it has a limited role to play (see previous post).
39% in Norway, 54% in the USA, 56% in Italy as three examples, presenting patients to emergency rooms are given imaging.
Even worse, opioids. Though data for effects of opioids for acute low back pain are sparse,
one study showed that they were prescribed for around 60% of emergency department presentations for low back pain in the USA.
More than half the total number of people taking opioids long-term have low back pain though NO randomized controlled trial evidence is available about long-term effects. Well, we can see some of the short-term effects taking place across our countries at the moment.
In terms of surgery, which has “a limited role for low back pain”,
studies from the USA, Australia and the Netherlands show frequent use of spinal fusion.
So the waste to our healthcare system is apparent, but the bigger cost is what’s happening to the people who are provided these treatments that have shown to have little success. They seem stuck in what seems a never-ending loop of pain.
“Guidelines recommend self-management, physical and psychological therapies, and some forms of complementary medicine, and place less emphasis on pharmacological and surgical treatments, routine use of imaging and investigations is not recommended.
Little prevention research exists, with the only known effective interventions for secondary prevention being exercise, combined with education, and exercise alone.”
Where do we go from here?
“Promising solutions include focused implementation of best practice, the redesign of clinical pathways, integrated health and occupational care, changes to payment systems and legislation, and public health and prevention strategies.”
Current guidelines need to be utilized which we clearly see, they are not. There needs to be better integrated education of health-care professionals including a change to the clinical-care model. Revamping the “current models of health-care reimbursement, which reward volume rather than quality”. Integration of health-care and occupation interventions so we can get people back to work and back to their lives. Changes to compensation and disability policies. Finally, public health interventions to change public’s beliefs and behaviors.
Which brings us to the last of the 3 papers, Low back pain: a call for action, up next on the blog.