Back Pain And The State Of The Art Medicine

With the advent of functional MRI (fMRI), research study of the human brain has advanced considerably and we are beginning to understand more about how our perceptions shape our healing process. It turns out that our perception of pain—not just the physical experience of pain, but our attitudes and expectations through that experience–can be the difference between making a recovery and getting stuck in a cycle of chronic pain.

Lorimer Moseley is a well-respected pain researcher and physical therapist. He is currently a professor of clinical neurosciences and chair in physiotherapy at the University of South Australia. Check out this video where Moseley explains (in good-humored, down-to-earth Aussie style) some of what makes pain science such a fascinating, surprising field.  One important takeaway: simply educating yourself about pain science leads to less pain!

Lorimer Moseley video: Pain–Do you Get It?

The medical community has begun to understand that opioids are not only doing very little to help those with back pain; these drugs often cause more harm than good. In light of this evolving thought and new research data, a model of care for acute back pain was developed in Australia outlining how doctors should be treating patients with acute (defined here as one to twelve weeks duration) back pain.  This model is the most concise and thorough we’ve seen, and one we’ve adopted here at Creative Therapeutics. While some of its suggestions may surprise you, I hope that the suggestion that physical therapy be used sooner and more often doesn’t surprise you at all!

First, the document differentiates severity of condition.  All back pain can be extremely painful, but research tells us that pain doesn’t necessarily indicate harm or danger.  There are specific types of pain and physical findings that warrant more testing (such as MRI) and others that don’t. Some of the findings indicating a need for more testing may include suspecting a fracture, pain that radiates down the leg or leg weakness, loss of bowel or bladder control, or signs that point to another disease process.

Pain that doesn’t fit into the above categories means a diagnosis of non-specific low back pain.  In fact, back pain, to date, can’t be entirely localized to a specific structure even if MRI findings show “damage” or “changes”.  We now know that these changes are normal processes of aging. Indeed, all of us undergo these changes and most of us will have some acute episode of pain at some point in our adulthood.  Here is where perception plays a key role: just knowing the results of an MRI can contribute significantly to continued disability and increase the length of time it takes to recover from back pain.

After all, low back pain hurts; we have heard stories of people never recovering (and maybe seen this first-hand); and we have heard possibly from family members that we have inherited a “weak back” in our families.  We are set up to fear back pain from the very start.  This feeling is contrary to the fact that most cases of back pain resolve within 1-6 weeks.

The recommendations in this model of care require that people work through the pain, that active treatments combined with some manipulative/hands-on treatment be employed in physical therapy, that people receive ample education about back pain, and that pain medication is limited.

The spine is an inherently strong structure and it can be returned to function.  When it comes to back pain, realizing that returning to full function is a process, and choosing practitioners who can teach you how to help yourself—these things happen to be state of the art medicine.