Back pain – the bright side

Back pain – the bright side

The functional restrictions that back pain often presents are numerous and particular to each and every individual. Photo:

The functional restrictions that back pain often presents are numerous and particular to each and every individual. Photo:

In plain and simple terms, eight out of 10 of all people reading this will experience back pain at some point in their lives – if you haven’t, unfortunately the likelihood is that you will.

A statement such as this would have probably sent shivers down your spine (excuse the pun). Those who have been through such an experience will understandably have recollections of a period of time where their lives had been severely conditioned by pain and a significant change in daily lifestyle.

Others, who have not yet been through such an experience, are probably expecting back pain to creep up on them at any second. In reality, and excluding physical trauma, there is no given definite period of time or pattern during which the onset of back pain can be predicted.

However, there is good news – and much more than we expect.

From the very first time we hear about back pain, we also hear about stories of prolonged periods confined to bed, multiple scans, strong medications, inactivity and also the dreaded wheelchair. This then leads us to believe that any pain coming from the region we refer to as ‘our back’ will have severe implications and is something that we should greatly fear.

The reality is somewhat different. There is a great stigma associated with back pain, which makes our perception of the situation much worse than it actually is. The negatives associated with back pain have been solidly drummed into us but we have neglected the positives.

The positives

As mentioned earlier in this article, back pain is extremely common. So common that one might continue to say that a bout of back pain is rather normal. Simply by keeping this fact in mind, we are now in a position to discuss back pain from the perspective of a normal situation rather than a stigmatised condition.

As healthcare professionals we usually refer to certain conditions through medical jargon. Unfortunately, to the non-medically trained individual, the sound of never-ending terms coupled with some Latin/Greek-sounding prefixes/suffixes make the situation all the more confusing. You do not need to be confused at all. Certain terms that have been developed over the years may sound daunting but they should not. In respect to back pain – the main culprits are: mechanical low back pain, non-specific low back pain, lumbago; and for possible pathologies to justify pain: spondylosis, spondylitis, prolapse, myopathy, neuropathy...

In short, all these terms refer to situations which describe or also attempt to justify the onset back pain.

What do they mean? A lot of situations describing normal and often expected changes in the spine that will occur naturally over time and that do not necessarily have any connection with any pain felt. In fact, you may have all of the above but be completely pain free.

To prove the above point, medical literature has shown that 90 per cent of individuals with back pain will not show any deviations from normal anatomy following diagnostic scanning of the back. The remaining 10 per cent will show change, however,  only a fraction of these could be deemed as serious.

This raises the issue of diagnostic scanning and the stage in which it is done. Without a doubt any back pain sufferers have either had or are seriously considering having an X-ray and/or MRI. For the individuals who have yet to experience back pain, the first thing probably to come to mind once in pain is actually having imaging performed to see what might be the cause of pain.

There is a great stigma associated with back pain

More good news – you do not need to have such imaging done unless certain signs and symptoms (determined by the clinician) are present, avoiding any unnecessary exposure to radiation in doing so. In addition, the absence of premature diagnostic testing will also help to avoid the  patients’ pre-conditioning or the progress throughout their rehabilitation process.

At this stage, the back pain sufferer has been subjected to the fear of pain, actual pain, scary nomenclature, unnecessary imaging, frustration resulting from non-conclusive imaging and functional disability. The remaining factor to complete this never-ending loop, which may result in an acute episode becoming chronic, is the use of medication.

The understandable implications of pain and functional restrictions that ensue trigger the patient to enter the world of ‘needing to be prescribed medication’. One cannot argue with the fact that the proper use of medication is advocated for. However, it is important that the nature, dosage and timeframe for prescription are correct. The improper use of medication will not only render it ineffective but may have undesired side effects.

Moreover, recent trends in the management of back pain are pushing towards the de-medicalisation of the patient management with the adequately prescribed exercise as treatment of choice. When discussing pain management one can mention the adequate escalation of treatment or the treatment ladder. Logically, treatment of any kind should start from the simplest forms and be escalated when assessments deem necessary.

Current sufferers, you have not been forgotten. Although this article has addressed past and future back pain sufferers, the current incidence of back pain is extremely high. The discussed points should positively alter the perception of back pain and the fear associated with it.

There is definitely much that can be done to help reduce and hopefully eliminate pain that is currently being felt. On occasions it is the simple and overlooked methods that might be the key to unlocking your natural pain relief mechanism.

As a person who is in pain, the first, possibly most important step towards progression is to understand the reason why you are in pain. In doing so, all of the other elements that may be blamed as causative factors will once again stop being perceived as threats. Clear examples are attributing the pain to posture, apparent exertion, comparison to other individuals’ experiences, body structure and scan results.

The functional restrictions that back pain often presents are numerous and particular to each and every individual. The different anatomy, lifestyle, age, past experiences as well as outlook are what make each of us individual and unique. Similarly, the way in which we experience pain is unique, which therefore varies from one individual to another. This would mean that the treatment of such cases should vary from one person to another and that there is no standard recipe for back pain treatment.

The general consensus (in the absence of serious pathology) is that movement is healthy for the back and that treatment should be targeted at restoring the ability to move well without provoking a painful experience.

Back pain is not necessarily serious and it does not need to be perceived as such. There are several misconceptions about the treatment of back pain and on some occasions the condition is over treated. Surely, back pain does not need to be as disabling as it is portrayed to be and there are many methods that one may employ to control it.

It is important to note that a consultation with qualified healthcare professional is advocated at all times to derive the problem and best fit treatment.

Luke Busuttil Leaver graduated as a physiotherapist in 2006 from the University of Malta and was awarded a Master’s degree in Musculoskeletal Science the year after by the University of London. He has a special interest in sports rehabilitation and chronic pain.

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