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Low back pain is a symptom NOT a disease! There are Acute and Persistent (Chronic) episodes of Low Back Pain. And sometimes there are acute episodes that happen on top of already persistent low back pain (ie. increased pain for a short period of time and then the pain goes back down to normal levels). What is the MOST likely cause of my pain?
90% of cases have NO specific structure at fault (ie. it could be any or no structure causing the pain) 1. This is called Non-specific Low Back Pain, I know this is an unsatisfying diagnosis!
Patients and back pain sufferers have the most trouble with this diagnosis. We as patients are trained to want to know the faulty structure because then we think we could fix it better. What is the LEAST likely cause of my low back pain?
compression fracture 4%
organ disease 2%
tumour or cancer 0.7%
infection 0.01% 2
But potentially more accurately likely fewer than 1% of Acute Low Back pain cases have a specific cause 3. Should I get an X-ray or Image of my low back?
NO, unless your primary health care team suspects major risk factors (ie. cancer, spinal infection or cauda equina syndrome (loss in control of bowel or bladder) or a disease process that would be managed differently then Non-specific Low Back Pain
WHY?
Because the imaging guidelines created from extensive research reviewing the harmful effects of imaging discourage imaging unless there are any of the high risk factors listed above.
Harmful Effects of Imaging
radiation exposure
normal results interpreted as pathology
costly and time consuming
Imaging does not improve clinical outcomes, meaning they do not positively change your pain experience or treatment plan.* 4 So what can I do to change my pain without meds?
Multimodal/Multidisciplinary Treatment Package
Massage (better for Acute than Persistent Back Pain)
Cognitive Behavioural Therapy (better in short term)
Exercise (Kinesiologist guided, pilates, yoga, tai chi, motor control)
Return to Work Programmes
Acupuncture and Dry Needling (better in short term)
What should I not do to change my low back pain?
Injections
Radiofrequency Neurotomy (severing the nerve to the spinal level)
***Epidural Steroid injection (limited effect for small group of patients only)
Prolotherapy (injection of irritating solution, usually glucose based)
Antibiotic Prescription
Spinal Cord Stimulator or intrathecal pump (no research results)
Surgery Consult
most often surgery is the last resort for Persistent Low Back Pain but commonly the results are no better than conservative outcomes as mentioned in the above Do's for Back Pain
All of the above Do's and Don't were summarized from the 2016 UK National Institute of Health and Care Excellence (NICE) draft guidelines 5, published Cochrane reviews 6-12 and American College of Physicians and the American Pain Society (ACP/APS) 13.
What is my Prognosis for Recovery?
The 42-72% of patient who undergo some of the above listed Do's for managing and treating low back pain will have a FULL recovery by 12 months 14-15.
Get on your PATH TO RECOVERY today and seek out a well rounded approach to managing and treating of your low back pain. Above all, make sure EXERCISE is part of the plan.
REFERENCES Thank you to Chris Maher, Martin Underwood and Rachelle Buchbinder for summarizing a large amount of research into one comprehensive article in the Lancet on Non-specific Low Back Pain; October 10, 2016. 1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006; 332:1430-34 2. Deyo RA, Weinstein JN. Low Back Pain. N Engl J Med 2001; 344:363-70 3. Henschke N, Maher CG, Refshauge KM, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary car settings with acute low back pain Arthritis Rheum 2009; 60: 3072-80 4. Chou R, Fu R, Carrino JA Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 2009; 373: 463-72 5. National Institute of Health and Care Excellence. Non-specific Low back pain and sciatica: management. NICE guideline: short version. March 2016. 6. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev 2005; 9: CD000335 7. Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev 2015; 9: CD001929 8. Furlan AD, van Turder MW, Cherkin DC, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev 2005; 1: CD0001351 9. Henschke N, Ostelo RW, van Turder MW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev 2010; 7: CD002014 10. Kamper SJ, Apeldoorn AT, Chiarotto A, Et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014; 9: CD000963 11. Maas T, Ostelo RW, Niemisto L, et al. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev 2015; 10: CD008572 12. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low back pain. Cochrane Database Syst Rev 2011; 2: CD008112 13. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain : a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147: 478-91 14. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008; 337: a171 15. Costa Lda C, Maher CG, McAuley JH, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ 2009; 339: b3829.