Back Pain ManagementPhysical and Psychological Treatments

Published July 2015 Updated December 2015 10 lectures
Mr. John O’Dowd FRCS Orth
Hampshire Hospitals NHS Trust and London practice, UK
Ms. Anna Hlavsova MSc, MCSP, HPC
Physiotherapist, UK
Summary

Back pain is a worldwide problem with high prevalence rates and an increasing impact on the every day life of people with chronic pain. It is the number one cause of disability worldwide (Hoy et al, 2014) and is consuming more and more finances and healthcare resources every year.... read more

Low back pain without radicular pain is the most common musculoskeletal complaint of people presenting to their GPs. Treatment of acute back pain or radicular pain should consist of self-management strategies, medication, physiotherapy and as little time off work as possible. For those who do not respond, appropriate screening, referrals and treatments should be offered with emphasis on so-called yellow flags (i.e. psychosocial obstacles). Persistent radicular pain with corresponding findings on MRI scans can be effectively managed with injections or surgery although appropriate selection of patients is crucial.

The biggest challenge remains chronic back pain and despite many treatments on offer, there are none with guaranteed success of improvement. The rates of spinal surgery have been steadily increasing since the 1990s with variable outcomes although these should no longer be offered as a treatment for mechanical back pain. Increasing focus on research should ensure that more effective treatments are discovered however reality is quite different. An increasing number of psychosocial predictors and contributors have been discovered with less attention on appropriate and helpful treatment. Despite guidelines pointing to effective treatments for chronic low back pain such as combined physical and psychological programmes, few of those who need it are offered it.

When it comes to chronic pain, it is difficult to obtain reliable objective information from patients who are in pain. The latest neuroscientific research has focused on the nociceptive processing in the nervous system, central sensitisation, behavioural and pharmacological mechanisms, all of which have enriched our understanding. Thanks to functional MR imaging, PET scans, EEG and the newest research methods, this has allowed us to gain a deeper understanding of the complexity of chronic back pain.

This series brings together experts in this field and will focus on all of the important areas including: acute and chronic pain, treatments for back and leg pain, the role of surgery, the biopsychosocial model, psychosocial factors, central pain, research methods and the way forwards.