Low Back Pain: a major global challenge

A study published by the Lancet in 2018, reported that almost everyone will have low back pain at some point in their lives. It can affect anyone at any age, with the biggest increase seen in low-income and middle-income countries. Disability due to back pain has risen by more than 50% between 1990 and 2015.

For nearly all people with low back pain, it is not possible to identify a specific cause (non-specific low back pain). Only a small proportion of people have a well understood pathological cause  e.g. a vertebral fracture, malignancy, or infection (specific low back pain).

Key messages:

• Low back pain is an extremely common symptom.
• Most episodes of low back pain are short-lasting with little or no consequence
• People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain.
• Disabling low back pain is over-represented among people with low socioeconomic status, where possibilities for job modification are limited.
• Lifestyle factors, such as smoking, obesity, and low levels of physical activity, that relate to poorer general health, are also associated with occurrence of low back pain episodes.

Prevention and Treatment of low back pain

• There is lack of evidence for prevention of low back pain: back belt, ergonomic furniture, work-place education, no-lift policies, mattresses, lifting device. The only known effective interventions (based on low to moderate quality evidence) are exercise combined with education, or exercise alone.
• Do not recommend passive electrical or physical modalities, such as ultrasound, transcutaneous electrical nerve stimulation (TENS), traction, short-wave diathermy, and back support for low back pain.
• No one exercise seems superior to another.
• Some guidelines do not recommend passive therapies, such as spinal manipulation or mobilisation, massage, and acupuncture, some consider them optional, and others suggest a short course for patients who do not respond to other treatment.
• Spinal imaging is inappropriate for non-specific low back pain ( Brinjikji at el. 2015).

 

 

 

 

 

 

• Interventional therapies (e.g. injections, surgery and medicines) have a limited role for non-specific low back pain.
• Non-pharmacological treatments in the form of advice, reassurance, and activity should be the first line treatmen option for non-specific low back pain.
• Paracetamol is not recommended.
• Consider oral non-steroidal anti-inflammatory drugs (NSAIDs), taking into account potential risks, and if using them, prescribe the lowest effective dose for the shortest possible time.
• Routine use of opioids is not recommended, since benefits are small and substantial risks exist, including overdose and addiction. If used, they should only be in carefully selected patients, for a short duration, and with appropriate monitoring.

Conclusions

Low back pain is very common and in most cases the pain is not caused by anything serious and will usually get better over time. The key factor is to keep yourself active and exercise. Remember that no one exercise seems superior to another. It is also crucial to avoid resting and do not use a back supports to protect your lumbar spine, otherwise you might end up in a vicious cycle: fear of movements –> muscle overactivity –> more pain.

There is a great ebook written by Dr Greg Lehman, a physiotherapist, which I highly recommend. The ebook is free and basically it helps you to understand pain.

 

 

 

References

Low Back Pain: a major global challenge, The Lancet, 2018;

2015. Brinjikji at el. 2015.