Last week, two articles appeared in the Economist describing the immense cost of back pain to society both financially and as the leading cause of disability measured by the number of years lived in poor health. The articles quoted a number of the world’s leading experts on pain and made some excellent points, substantiated by research evidence, that should be more widely publicised. These include:
This was depressing reading for me. I have worked in clinical practice for nearly 30 years, attending courses and conferences, and reading literature to improve and develop my understanding of “back pain”. I put “back pain” in inverted commas as it is widely accepted that back pain is multi-factorial, due to a combination of physical, psychological and social factors unique to the individual. This was one important point that the articles failed to highlight. The articles talk about back pain being caused by altered pain processing in the brain, and while this is a scientifically substantiated factor in some cases of back pain, it is not the cause of all back pain, any more than what is seen on a scan is the cause of a person’s pain. Every person with back pain has a different combination of factors that need to be addressed in order to achieve a successful outcome. For this reason, they need to be managed by clinicians with expertise in this area.
In my 30-year career, I have also done a lot of teaching and lecturing on the assessment and management of back pain to Physiotherapists, Doctors, Osteopaths, Chiropractors, and Strength & Conditioning Coaches. I talk regularly about the need for consistent messages to patients and approaches to management, so patients can have faith in the information and suggested management plan they are being provided with, and don’t feel they are being “fobbed off” by a GP who says an MRI is not needed or a physio who says a referral to see a surgeon is not appropriate. Recently I attended the World Congress on Pelvic and Low Back Pain, where all of this information was discussed. The audience, a complete mix of all the disciplines involved in managing back pain, was full of people nodding their heads in agreement, which is when I realised how much time clinicians and researchers spend preaching to the converted. We need to spread the message further to other clinicians, patients, their families and friends.
To begin to solve “the problem of back pain”, we need to do the following things:
The title of one of the articles in the Economist was “The burden of back pain — Back pain is a massive problem which is badly treated”. Personally, I think a better title would have been “Back pain is a massive problem which is poorly understood by most patients and many clinicians. Education is what will change this.”