Last year I posted a couple of blogs on lower back pain and the papers that had been published on lower back pain in the Lancet. If you haven’t read these papers I would advise you to do so. They were a global study and highlighted a lot of the misconceptions about lower back pain. They also highlighted some of the challenges to improving back care. Here is the link to the papers on the Lancet website: https://www.thelancet.com/series/low-back-pain
For me these papers were important because they represented a shift in the way we approach lower back pain. A shift away from the biomedical model to a biopsychosocial approach. A model where we take into account what is happening in someone’s life and their beliefs about pain and not just focus on finding a damaged structure in someone’s back and treating that. For the majority of people with lower back pain there is no structural cause for the pain. Studies have shown that prolapsed discs and facet joint arthritis are as common in people without pain as they are in people with pain. In some cases there are more serious causes of back pain, but these are rare and most people have what’s known as non-specific lower back pain.
The Lancet papers highlighted that a lot of treatment that focused on the structure in someone’s back, like supports, injections and some surgery aren’t very effective. They also highlighted that MRI scans and x-rays are not always necessary as they can often make people more anxious about their back if something is found, even if it is unrelated. The studies report that medical intervention can make people’s pain worse over the long term if it is purely focused on a structural problem or if things aren’t explained properly.
These are some of the reasons why I set up the Bristol Pain Relief Centre. I felt there needed to be a different way of approaching lower back pain. Over the years I have seen many people with chronic lower back pain who are afraid to move or do activities they previously did for fear of damaging their back. They may have had an MRI scan or an x-ray and have been told that there was a disc bulge causing their pain or some wear and tear or they may have been told that there was something out of alignment. Either way they thought there was something wrong with their back and began to protect it. This belief that something is damaged makes the pain worse as our nervous systems become more protective of our backs and the amount of activity you do becomes less and less.
I’ve also seen people who have developed a fear of the pain itself. People become afraid to move because the pain may come on. This also leads them to adapt their lives and become less active. The important thing to note is that pain does not always mean damage. Pain is an alarm system that can be triggered by our brains and central nervous system in response to a perceived threat. But often it is the perception of threat that causes the pain rather than a threat itself. Helping people to understand this can be very useful. By knowing that they are not going to damage themselves it helps build confidence to move again, which in turn helps switch off the protective pain mechanism.
When treating people with long term lower back pain there are also other factors to take into account. Emotional factors past and present can play a significant role in how our nervous systems respond. It can make our nervous system become hyper-responsive to information. Meaning something that shouldn’t cause pain now does. This pattern can become stronger over a period of time and unknowingly people can be doing things that reinforce this pattern, creating a viscous cycle. Our beliefs about the causes of pain can influence the pain we experience.
This was highlighted in the lancet papers that we need to recognise that social and economic factors, as well as personal and cultural beliefs are all associated with someone’s back pain. If we don’t recognise this going forwards it may lead to back pain becoming even more of a global problem.
This is why over the years I have shifted from focusing on back pain as structural problem and focused more on the person. Pain is often a physiological response triggered by physical, emotional and cognitive factors and not just a structural problem. I have found it very useful to shift away from pain as purely a physical problem and treat the person, not just the area they have pain. I’ve seen many people with long term pain recover, by looking at their pain from a different perspective. It’s not always easy to do, particularly when someone has become afraid to move, but it is possible.
If you want to find out more about this different way of working, then why not give me a call on: 07976 926347 or send me an email to firstname.lastname@example.org. We can book in a free 30 telephone consultation, where I can explain the approach in more detail.