While most adults suffer from low back pain at some point, persistent and ongoing pain beyond three months is less common and can act as a more severe condition which affects all aspects of a person's life. It is essential to find out why the patient is suffering and focus on physical and psychological wellbeing.
The most important consideration at this point is to determine why the patient is suffering accurately.
So, what is the diagnosis?
Regarding back pain, finding the cause or determining the underlying diagnosis is key. Most people believe that there must be some structural changes in the spine, such as degenerative disorders or an injury that cause the pain. However, structural disorders are not the cause of back pain in some cases. This does not mean no cause can be found, and a thorough check-up can be helpful. This multidisciplinary model of care, known as the biopsychosocial model, aims to tease out the different parts of a person’s condition. Some patients have greater psychological, social and emotional effects with less physical ill-effects from their back pain; other patients have the reverse: pain driven by a structural abnormality in the back. Clinical questionnaires can often identify what aspects of the pain are most relevant.
Radiographic (x-ray) imaging is often unnecessary with acute low back pain, which is self-limiting, but with persistent back pain, the patient will most likely warrant erect radiographs, to analyse spinal alignment. An MRI scan can evaluate the soft tissues such as the discs, muscles, ligaments and fascia. MRI has limitations in that it may highlight abnormalities from wear and tear that may not be attributable to the patient's current pain. Many findings don't have to be considered a problem but are part of normal ageing. Importantly MRI may exclude potential diagnoses that heavily affect a patient's mind, such as cancer. However, risks like this can be identified in other ways, including through a patient's clinical history, considering aspects such as smoking, unexplained weight loss, and personal history of cancer.
Your spine specialist, doctor, spine surgeon or physiotherapist will evaluate posture and how the spine moves, a crucial aspect of back pain assessment. Information from the x-rays and scans and clinical information from the doctor are also key to empowering the physiotherapist to provide treatment.
Any exercise is good. The role of a health therapist is to work with you to overcome any fears about harm and find what exercises suit you best to improve your function.
A general exercise programme that combines muscular strength, flexibility and aerobic fitness benefits many patients. Increasing core muscular strength can assist in supporting the lumbar spine. Aerobic exercise increases the blood flow and nutrients to the soft tissues in the back, improving the healing process and reducing stiffness. However, amid severe pain and low morale, the motivation to start and persevere with exercising can be low and quitting can be tempting. Supportive family, friends and healthcare professionals are crucial to reinforce the message of persevering, first with easy non-painful movements, then as confidence builds, achieving more and getting spinally fit. It can be a long journey, and there may be setbacks along the way.
Psychological wellbeing should be considered in all patients with persistent low back pain. It is worth bringing a 'significant other' friend or relative to any consultation to share the understanding of the process and to have them support you. People can struggle to understand how they have arrived at a place of distressing pain. The knowledge that it is not a sinister or life-threatening condition may reassure. A reasonable explanation and a positive message of reassurance can help reduce the disability that comes from the pain. This message is even more empowering if shared by the healthcare team so that everyone is on your side and there are no mixed messages which can be confusing and frustrating.
Successful treatment of disabling back pain requires active patient participation and is typically based on various measures. Treatment strategies can include exercising, learning more about effective self-management and understanding when best to use pain control pharmacology. Learning what is best for different pain types helps you have that shared discussion with your healthcare professional. Very often, multidisciplinary teams of health care professionals work together to try and provide the best solution to your disabling back pain. They are working together with you and for you. Often single treatments for disabling back pain must be combined for greater effectiveness. Interventional procedures, such as surgery, have a higher level of risk of harm than non-interventional treatments and should only be considered when there is a clear structural disorder associated with the pain. It seems the longer pain has gone on, the more likely multimodal or combined therapies will be effective in helping. Moving from one treatment to another treatment and then another treatment is not helpful. The combined multidisciplinary approach combines effective strategies to get you into a better place for the long term.
EUROSPINE is a society of spine specialists of various disciplines with a large knowledge of spine pathologies. All well-known and accepted treatment modalities for spine pathologies are represented by the members of the society. However, the Society cannot accept any responsibility for the use of the information provided; the user and their health care professionals must retain responsibility for their health care management.
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