News

13-03-2016

Low back pain is the number one cause of years lived with disability in Australia and globally ( MJA 2008:189), causing more disability than the sum of cancer, heart disease, AIDS and stroke. It is estimate that 80% of Australians will experience back pain at some point in our lives, commonly leading to a GP visit.

1 :Back Pain usually gets better without intervention

Most cases of acute back pain will recover fully over the next weeks to  occasionally months, even if severe at the start. Reasons to consult a doctor are:

  • Pain radiating down a leg, or constant pain not easing with lying down or resting
  • Muscle weakness, pins and needles, or numbness, especially after a recent trauma or injury
  • Abnormal bladder or bowel symptoms associated or unexplained weight loss, fever or nonspecific un-wellness
  • Associated chronic illness such as osteoporosis
  • Severe pain not improving after a week

2 : Paracetamol is unlikely to relieve the pain

Although international guidelines have advised doctors to use paracetamol as part of acute back pain management for many years, a large, well run study last year demonstrated no benefit from the drug. There was no improvement to recovery, no relief of pain and no benefit to function with the pain.

There is also little evidence that over the counter anti-inflammatories are of benefit.

Some benefit has been found with manual therapies from physiotherapists, chiropractors, osteopaths and some doctors. These may also help change daily activities to reduce pain.

3 : Back pain is not always the result of injury

Soft tissue strains and tears do occur, as do fractures and disc degeneration, but the structures of the spine can become sensitised due to other factors such as anxiety, stress, low mood and lack of sleep.

Your back is more vulnerable to strain and pain if in poor condition, for example those who do not exercise, lead a sedentary life, are overweight, who smoke and have sustained poor posture.

4 ; Rest is not the Treatment

Previously the advice was to lie down and rest in bed. Studies have shown that bed rest is unhelpful and may delay recovery. It is recommended that tissues heal more quickly is gently loaded, with severe pain this may be by taking a break between activities or  using  a physiotherapist to advise about stretches and gentle activities to carry out. Avoiding twisting and heavy lifting and strenuous activity initially is obvious, walking, yoga  and swimming are recommended early in recovery.

 

5 : Scans are not likely to help

 Evidence shows that scans do not improve recovery and may increase cancer risk due to radiation exposure associated. The images can also highlight abnormalities of no relevance which may cascade further investigations. There are some occasions requiring an image, such as a past history of cancer, age over 70 years,   weight loss and fever associated, trauma, corticosteroid treatment, new lower limb or bladder motor symptoms, recent invasive procedure

There is a simple classification used by your GP    to evaluate a person with acute low back pain  and whether imaging is advised as suggested by The Royal Australian and new Zealand College of Radiologists.

  • LBP associated with sciatica or spinal canal stenosis
  • Serious spinal pathology ( cancer, infection, fracture)
  • Nonspecific low back pain ( 90% of presentations)

6: Prevention

  • Exercising regularly improves muscle strength and general fitness
  • Lose weight and maintain the weight loss
  • Take care lifting and carrying, reduce prolonged sitting, vary positions and improve posture
  • Don't smoke, smoking reduces the vascular supply to structures and inhibits healing
  • Get adequate sleep
  • Manage stress

7: Back pain can become chronic

Pain Specialists and  Pain Clinics help people manage their pain and return to their activities  despite the pain.

A rehabilitation plan is crucial, aimed at reducing symptoms, pain and disability by developing health lifestyle habits and confidence . Medications, even surgery ( for significant neural impingements or gross radiological instability not responding to conservative management ) procedures may have a role, especially to improve function. A programme may include a combination of group therapy, exercises, relaxation, education and information on the psychology of pain.

Resources:

Pain Bytes : http://www.aci.health.nsw.gov.au/chronic-pain/painbytes

Pain Health WA website : http://painhealth.csse.uwa.edu.au

Retrain Pain : www.retrainpain.org

 

TEDxAdelaide - Lorimer Moseley - Why Things hurt https://www.youtube.com/watch?v=gwd-wLdIHjs

pain-ed.com

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