Rethinking back pain

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03 September 2019

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Is a bad back making your life a misery?

Contrary to what you might think, many doctors agree that ‘motion is lotion’ when it comes to managing pain. Here are the benefits of including movement in your care plan.

If you don’t suffer from back pain, you probably know people who do. Currently 3.7 million Aussies have back pain and the Australian Bureau of Statistics National Health Survey 2014-15 estimates between 70 and 90 per cent of people will have some kind of back pain during their life. More alarmingly, global researchers, including experts from Australia, Scandinavia and South Africa, say low-back pain is the leading cause of disability worldwide. According to the Australian Pain Management Association, while specific low-back pain conditions are rare (those with a cause) – about five per cent of cases – low-back pain in general is the third-most common condition people see their doctor about. So, what can we do about this debilitating issue?  

Medical professionals say, don’t get too medical about it. “Management of back pain is changing,” says Dr John Mayhew, New Zealand Warriors rugby league team doctor and member of the Best Doctors global network of specialists. “It’s being overtreated and over X-rayed.” In the past, people may have had medical imaging that would show wear and tear but Dr Mayhew believes this negatively impacts how people perceive back pain. “If you X-rayed one thousand 50-year-olds, it may reveal degenerative disc disease, but this is just wear and tear.” Once this becomes a diagnosis, people think they have a ‘bad back’ and therefore shouldn’t work and shouldn’t exercise. This is far from the perfect prescription. “They’ll become deconditioned and could put on weight,” adds Dr Mayhew. “Sometimes more harm is done by over-investigating and labelling people.” 

Even the National Health and Medical Research Council guidelines state that scans for acute low-back pain are often unnecessary unless there are signs of something more sinister.  

What causes acute low-back pain?

Although most causes of acute low-back pain are a mystery, research – including a famous study more than 10 years ago from the European Space Agency – shows that sedentary lifestyles and sitting at desks for lengthy periods of time can shrink the muscles that protect our back. The message here is that regular movement and physical activity must be factored into our days no matter how busy we are.  

Motion is lotion

When it comes to back pain, medical advice now seems to be: keep moving. “Someone with severe back pain will need to be assessed by a health professional, but a minor strain is likely to settle down within seven to 10 days,” says Dr Mayhew. “Don’t take it easy – do as much activity as your symptoms allow.” 

A series of papers from respected professionals across the world, led by Professor Rachelle Buchbinder from Melbourne’s Monash University, published last year in The Lancet recommend people with back pain move through it as an alternative to medical treatment in the first instance. The researchers say there’s “inappropriately high use of imaging, rest, opioids, spinal injections, and surgery – doing more of this will not reduce back-related injury.” They continue: “the advances with greatest potential ensure promotion of activity and function, including work participation.” 

For most non-specific back pain, where there’s no real cause, Dr Mayhew offers the following treatment plan. “Time is a good healer and most back pain will ease quickly with paracetamol or NSAIDs (non-steroidal anti-inflammatory drugs) and regular aerobic exercise.” 

That’s not to say this will work for everyone – back pain is complex. “There will be subgroups that need medical investigation – it’s about screening out the ones who need intervention,” adds Dr Mayhew. If you’re concerned about acute low-back pain, see your healthcare professional. This document – Best practice care for people with acute back pain – from the NSW Agency for Clinical Innovation as part of the NSW Government’s health department – may also be a good starting point. 

About Best Doctors

With an eligible policy from MLC Life Insurance, you and certain of your family members can access Best Doctors – a service which connects you with a network of more than 50,000 leading medical specialists from Australia and around the world for a second medical opinion when you need it most, helping to ensure you have the right diagnosis and treatment plan. Learn more about Best Doctors.

References

  1. https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/what-are-back-problems 
  2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext#%20
  3. https://www.painmanagement.org.au/2014-09-11-13-34-03/2014-09-11-13-35-16/118-low-back-pain.html
  4. https://www.sciencedaily.com/releases/2007/06/070607071226.htm
  5. https://www.aci.health.nsw.gov.au/resources/musculoskeletal/management-of-people-with-acute-low-back-pain/albp-model
  6. https://www.thelancet.com/series/low-back-pain 
  7. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/363450/ALBP-Consumer-Info.pdf
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