Low Back Pain: State of the Art

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Recently Independent.ie published an article about low back pain which talked about some of the most common triggers. Frankly, it was one of the most outrageous articles written on the causes of low back pain. It was as if research doesn't count for anything. One of the assertions was uterus can push back on the spine causing inflammation of spine.... just utter rubbish.... with no consideration of evidence or anything.. Twitterati went into hyperactivity in challenging the basis of assertions.. calling out the biased facts.... and finally the article was removed from their website.. 

But the positive news is that The Lancet and their Low Back Pain Series Working Group has come up with a series of articles on low back pain which summarise the state of the art. The articles have been authored by the best in the business of researching low back pain and clearly present the evidence for this most common low back clinical presentation. 

The first article is titled 'what is low back pain and why we need to pay attention.' This article presents the global burden of low back pain as the leading cause of disability worldwide. But more importantly it highlights that only a small proportion of people have a well understood pathological cause—eg, a vertebral fracture, malignancy, or infection. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. It goes on to discuss that that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain.

The second article focusses on the prevention and treatment of low back pain. The key focus is on utilisation of education and self management as the key interventions as opposed to inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. I was shocked recently when having a conversation with one of the colleagues who is starting some work in Australia and mentioned that it has been recommended that all patients will undergo an initial MRI scan... not sure who devises such recommendations... but anyway, back to the topic.. the key focus is on moving away from therapies which have little evidence for benefit but surely work to move the locus of control from the patient to the therapist and therefore ensure that the patient keeps turning up in private practice. While researchers have said that for a while now, unfortunately, both the patients and physiotherapists continue to utilise the same passive therapies to manage low back pain. The authors have also highlighted the role of psychological therapies in managing chronic persistent low back pain. If you work with low back pain patients, this article is well worth a read. 

Finally, as a call to action, the Low Back Pain Series Working Group has recommended focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.

All these articles are available free



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