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Low Back Pain on the Rise - what is the best treatment for it?

Calendar Mon, 14 Sep 2015Share

Back pain is one of the most common pain problems that we suffer from in the Western world, and New Zealand is no exception to this. The use of what we call ‘diagnostic’ imaging  (such as MRI scans or x-rays) that are used in trying to help find a ‘cause’ of the pain, also continues to increase. This in turn leads to more interventions such as medication, manual treatment such as physiotherapy or chiropractic, injections, and surgery – which in turn often leads to more diagnostic imaging! And so the circle continues, as do the costs. 

Yet there is strong evidence in science these days that what was previously considered tissue “damage” on scans, is actually common amongst people without pain, ie. You can have no symptoms of back pain, but if we scanned or x-rayed you, we may find that you have the same tissue changes as those that complain of back pain. As well as this, there are a number of people that have treatment to address this ‘damage’ found on imaging, that fail to improve at all. So what is this telling us about our treatment of back pain? Are we looking in completely the wrong direction?

An increasing amount of research now shows us that cognitive and psychosocial factors are a big predictor of back pain. In simple terms, this means that the way we think, view and perceive the world, and everything that is going on in our lives at the time, may have an impact on our chances of developing back pain. In particular, depression, anxiety, fear and stress are linked to the chances of the back pain becoming long-term and persistent. This isn’t to say that everyone that has back pain fit in this category, nor is it saying that everyone with depression or anxiety will develop low back pain – but it does tell us that there are strong links between the two.

One of the problems with our treatment of back pain is that we as health professionals are probably inadvertently doing much to cause some of that stress, anxiety and fear, by the language we use, the tests we are sending for, and some of the treatments we are recommending. By overly ‘medicalising’ back pain descriptions (eg. your disc has slipped, your sciatic nerve is being compressed), sending people for early investigations that are in all likelihood going to show the same as someone without back pain, and making people rely on passive treatments to ‘cure’ the problem, we are potentially setting someone up for a mindset of longstanding and recurrent back problems.

So what is the answer? Knowing some common truths about back pain for a start can help, for example knowing that

  • 90% of back pain is simple and will settle within 6-12 weeks without the need for costly investigations
  • keeping activity and daily behaviours as normal as possible when in pain is helpful, and
  • some age-related changes in your discs and joints in the back is normal

will help to reassure a lot of people when they are suffering from back pain. It is always important if you are worried to get your pain checked by a health professional such as a doctor or physiotherapist to make sure there are no obvious signs of anything more serious – but on most occasions, advice, education and a period of treatment, where you are being shown how to actively do things to help manage your pain and return to normal movement and activity will be enough to settle your symptoms, and decrease the chances of developing a long term back problem. If you do have long-term low back pain – try stepping back and figuring out whether your thinking, mood, and other things in your life seem to impact on your pain, and make adjustments as need be, and also consider whether you are seeking endless treatment or investigations to try and find the ‘cause’ of your problem – as this may in itself be part of the ongoing cycle of your ongoing back pain.