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Disabling Back Pain

While most adults suffer low back pain at some point, persistent and on-going pain beyond 3 months is less common and can act as a more severe condition which affects all aspects of a person's life. Therefore, it is important to find out why the patient is suffering but also focus on the physical and psychological wellbeing.
The most important consideration at this point is to accurately find out why the patient is suffering. What is the diagnosis?

It is understandable that a person with back pain wants to know the cause or the underlying diagnosis. 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, it should be noted that in some cases structural disorders are not the cause of back pain. However, this does not mean that 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 that is 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 as a problem but are part of normal aging. Importantly MRI may exclude potential diagnoses that bear heavily on 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 a treatment.

Any exercise is good, and the role of a health therapist is to work with you to overcome any fears about harm and find what exercises suit you best so that you can improve function.
A general exercise programme that combines muscular strength, flexibility and aerobic fitness has huge benefits for 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, in the midst of 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 upon the way.

In all patients with disabling persistent low back pain, psychological wellbeing should be considered. It is worth bringing a ‘significant other’ friend or relative to any consultation to share 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 that 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 types of pain helps you to have that shared discussion with your health care professional. Very often ‘multi-disciplinary‘ teams of health care professionals work together to try and provide the best solution to your disabling back pain. Working together with you and for you. Often single treatments for disabling back pain need to 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 that is associated to 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.
The Patient Line website offers information for patients with spinal conditions:
Sciatica, back pain, spinal stenosis, disc herniation, scoliosis and many other spine conditions explained in a clear reliable, and trustworthy way. Not for profit EUROSPINE experts are here to help patients and their families understand what may be worrying them.

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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