The Facts About Low Back Pain

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Lower back pain is one of the most common conditions that we treat at Keilor Road Physiotherapy, so we thought we would share some of the statistics and take a closer look at the causes of low back pain.

Low back pain is a common condition affecting many individuals at some point in their lives. On any given day close to 30% of the Australian population will actually be experiencing low back pain (1,2) and low back pain is the largest health burden currently in Australia and third in the Western world. So the first take home message is that if you are experiencing an acute episode of LBP don’t panic, you are not alone!

Whilst this may sound grim, it should be understood that only a small amount of people, that is between 1-5% are experiencing low back pain that is due to a serious pathology and the majority of those experiencing low back pain will improve their symptoms within the first 6 weeks. For the vast majority of people (a huge 95%) that go on to experience persistent, defined as greater than 12 weeks duration, low back pain there is actually no specific structure that can be identified as the pain source.

For many years the accepted medical model has tried to identify what structure or pathology is the cause of persistent low pain, at a detrimental cost not only to the health system, but more importantly to the individual patient (4,5). Increasingly sensitive imaging for low back pain, such as MRI’s are often revealing normal age or activity related spinal changes that may be incorrectly diagnosed as the structural cause of a patient’s symptoms and then if the “tissue is believed to be the issue” this can lead into a spiral of stress, anxiety, sleep disturbance, fear of movement and fear of re-injury, all of which become significant in contributing in a negative way to the overall pain experience. These issues will be addressed in our upcoming blogs when we explore the psychological contributors and predictors to persistent pain.

 So it is really important to understand that often an MRI is not the first port of call in the management of low back pain. Consider the results of a major 2015 review by Brinjikji et al: signs of degeneration are present in very high percentages of healthy people with no problem at all. “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”(6)

Although it is true that the management of low back pain can sometimes be complex, there is a recently published paper that is so hot off the press, it’s actually still smoking!

The study in question examined 150,000 insurance claims involving people with back pain in the Unites States. Patients who saw a physiotherapist first were 89% less likely to be prescribed opioids, and 28% less likely to have advanced imaging services (MRI, CT scan, etc.). Out of pocket costs were also significantly lower for these patients (7).

“Given our findings in light of the national opioid crisis, state policymakers, insurers, and providers may want to review current policies and reduce barriers to early and frequent access to physiotherapists as well as to educate patients about the potential benefits of seeing a physiotherapist first,” said lead author Dr. Bianca Frogner.

We will have a lot more to say about the best management strategies for both acute and persistent low back pain as we develop our new blog section. One thing that is absolutely clear though is that as leaders in Physiotherapy, not only in the clinical field, but as those involved in developing and teaching the best management of these conditions at a post-graduate level in our profession across Australia, our team at Keilor Rd Physiotherapy definitely has your back!

 

1, Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. The Spine Journal. 2008;8(1): 8-20.

2, Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6): 968-974.

3. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6): 2028-2037.

4. Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. Journal of Manipulative and Physiological Therapeutics. 2004;27(4): 238-244.

5. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2): 149-165.

6 Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811–6.

7. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs
Bianca K. Frogner Ph.D.  Kenneth Harwood Ph.D., P.T., C.I.E. C. Holly A. Andrilla M.S. Malaika Schwartz M.P.H. 
Jesse M. Pines M.D., M.B.A., M.S.C.E. First published: 23 May 2018 https://doi.org/10.1111/1475-6773.12984

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