A new study on back pain in the prestigious medical journal, the Lancet, roundly criticises medical treatment of low back pain. Researchers from all over the world took part and looked at how back pain is treated, and they concluded that there is 'inappropriately high use of imaging, rest, opioids, spinal injections, and surgery.' They go on to say that 'Doing more of the same will not reduce back-related disability or its long-term consequences.'

Back pain is now the number one cause of disability globally and rates have continued to rise in spite of increased spending on treatment. The authors make a plea for more sense and evidence-based treatment. They call for a new direction which encompasses emerging treatments alongside effective solutions that exist already.

Effective treatment for back pain.
Guidelines exist for doctors to follow on the most effective sorts of treatment but often these are ignored or not implemented properly. Here in the UK, NICE (National Institute for Health and Care Excellence) has issued guidelines and these are mentioned in this study as being helpful and they echo the findings in this paper. The evidence points to a biopsychosocial model of care which looks at the behavioural, psychological, and social factors as well as the anatomical structures which play a role in the persistence of pain and disability.

What does this mean for you if you have back pain?
It means that there is greater emphasis on self-management, physical and psychological therapies, and some forms of complementary medicine, and less emphasis on pharmacological and surgical treatments. So staying active, doing gentle exercises, getting some manual therapy as well dealing with stress, anxiety and depression, especially negative feelings around pain and disability, are very helpful. One thing the guidelines in the US Denmark and UK agree on is that spinal manipulation is helpful. Which is good news because that’s what we do here at Well Adjusted Health.

Back pain is not one condition.
This review is an excellent summary of the worldwide management of low back pain but has its limitations. Back pain is not one condition but several conditions causing a similar group of symptoms. A muscle spasm, disc derangement and a spinal joint dysfunction all cause low back that can refer pain down to the buttock and leg and a skilled clinician can tell which problem it is likely to be. Whilst several conditions can co-exist it is clear that an accurate diagnosis is important because the treatment is different for all three. At Well Adjusted Health we make sure we make an accurate diagnosis and agree a treatment plan that is the most likely to get the best results.

Reference:
Prevention and treatment of low back pain: evidence, challenges, and promising directions.
Foster, Nadine EBuchbinder, Rachelle et al. The Lancet, Volume 0, Issue 0, 21 March 2018

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