Last week the Lancet journal released three key papers on low back pain detailing current understanding of back pain and its impact, prevention and treatment. While the results are not wildly radical or new, they are a helpful reminder of the worldwide impact of back pain and usefully highlight which treatment approaches are effective and which are harmful.
Below is a summary of some of the key messages from the papers that you might find useful if you suffer from low back pain.
Low back pain is the number one cause of disability worldwide. This has increased more than 50% since 1990 and is expected to get worse. Low back pain is a complex condition with a number of factors contributing to the pain and disability including psychological, social, biophysical and pain-processing mechanisms i.e. pain as an input to and output from the brain.
The authors state that:
“For the vast majority of people with low back pain, it is currently not possible to
accurately identify the specific nociceptive source”
What this means is that back pain can rarely be put down to one specific physical/structural cause. Almost all cases of low back pain are non-specific. Most episodes are short-lasting but recurrence is common and sometimes back pain will become persistent.
Lifestyle factors such as stress, smoking, obesity and poor physical activity are associated with low back pain episodes. Big contributors to back pain are psychological and social factors and how the brain processes pain is also very important. Unfortunately, very little is known about how to prevent back pain.
Evidence shows that a number of approaches can be effective for treating pain but sadly this is not often seen in practice i.e. many health professionals are not implementing evidence-based guidelines. Advice given is often outdated and ineffective.
What approach works for Low Back Pain?
Guidelines recommend the use of the biopsychosocial model to assess and manage low back pain because of its complex, multi-factorial nature. This approach includes:
- Education and advice on the nature of pain and what factors may increase or decrease it.
- General advice to keep active, including remaining in work, and avoiding bedrest.
- Exercise, relaxation and psychological therapies such as CBT and mindfulness.
- Participation in graded exercise/activity programmes with a focus on improving function.
- Complementary treatments may be helpful but passive treatment in isolation, such as spinal manipulation, is not recommended.
- Less emphasis should be given to medication, injections and surgery.
- Lab tests and imaging should not be routinely used as part of early management, only if a serious condition is suspected.
I get asked a lot what the difference is between an osteopath, a physiotherapist and a chiropractor. For me, I believe it is far more important that when looking for a physical therapist you choose someone who is up to date with current best practice and actively implements these guidelines. There is good evidence out there on what works for back pain, but these recommendations will only work if they are being implemented in practice.
For more information a link to the articles is here: