LOW BACK PAIN
Low back pain is a major cause of disability in Australians and the most common complaint we see in our physiotherapy practice. It is estimated that 70-90% of people will experience back pain at some point in their life. The Australian bureau of statistics states that 3.7 million Australians suffer from back pain which equates to about 16% of the population.
Despite these alarming statistics, low back pain is poorly treated and often, ineffective management is provided leading to poor outcomes and long term pain and disability for sufferers. Recently a large study was performed and published in The Lancet journal reviewing all the available literature on treatment for low back pain.
What they found was that being encouraged to stay active, an individualized exercise program and psychological therapies (psychology, relaxation, stress reduction) had the greatest benefit and evidence of improving pain.
Specifically with acute low back pain (back pain of 6 weeks duration or less), the evidence shows advice to remain active, education on back care with work, lifting and activities of daily living along with manual therapy such as spinal mobilization, massage, acupuncture and heat therapies are effective in reducing pain.
With persistent low back pain (back pain lasting greater than 12 weeks), advice to remain active, education, a specific exercise program tailored to the individual, cognitive/psychological therapy and manual therapy / massage are effective for management of pain.
The guidelines suggested that medications are not effective in the early stages of low back pain and should only be recommended if non-pharmacological management has not been successful initially. In this case anti-inflammatory medications should be the preferred choice. Routine use of opioids (strong pain killers) is not recommended as benefits are small and the risk of addiction is considerable. Only in a select group of patients identified by a doctor, with appropriate monitoring, should opioids be considered.
Epidural or facet joint injections show no long term benefit over conservative management for back pain. They should only be considered for severe nerve compression and related pain.
Surgeries such as spinal fusion and spinal decompression surgery can be effective for patients with progressive neurological deterioration but show similar outcomes for non-radicular(nerve) low back pain when compared to conservative management.
So what does all this mean for sufferers of low back pain?
The evidence shows that physiotherapy, manual therapy and massage, in conjuction with good education and advice on back care should be the first line of treatment for acute low back pain. If pain persists for greater than 12 weeks then treatment should shift to an individualized exercise program focusing on improving movement, strength and function for the patient. Cognitive therapy can be considered as part of the overall management of the condition. Investigations such as X-ray, CT scan and MRI along with specialist referral are appropriate in conditions with ongoing and deteriorating neural compression and pain.
Physiotherapists are ideally placed to diagnose back pain conditions and deliver appropriate treatment, education, advice and exercise programs for sufferers of acute and persistent low back pain. People need to be informed on the nature of their condition and on the best course of management. A positive outlook, guided by the latest information can empower back pain sufferers to take control of their pain and build towards good health again.