Almost four million Australians suffer from back pain every year and while the prevalence is relatively similar for males and females, ongoing back problems are more common as you move beyond 55. When you consider this, it’s not surprising that you might know lots of people who see a physiotherapist, chiropractor, acupuncturist or doctor regularly for their pain.
It’s interesting to note that while most people who have low back pain recover within a few weeks, a proportion report having recalcitrant pain for months and even years. This is where it becomes harder to treat and knowing what to do can become confusing.
Some people love seeing their physiotherapist regularly and some swear by their chiropractor or osteopath. More and more people are having regular acupuncture to help manage their pain and some rely on their GP for advice. You may even know someone who goes to a pain clinic or sees a psychologist to help manage their back pain. There is a lot of information out there and so many different treatment options to try.
Why is low back pain so complex and why isn’t there a straightforward treatment option that helps everyone?
Once you’ve had back pain for more than 12 weeks, the acute phase of tissue damage and inflammation has usually settled down, so there are other issues that start contributing to the pain. Pain is very complex, and it doesn’t always mean there is ongoing damage to tissue or structures in the back.
Some people become fearful of movements or activities that might aggravate their symptoms, some may catastrophise or imagine the worst possible things happening to their body when their pain is bad. Some people lose their confidence to go to work or enjoy time in the garden or to just bend over to unpack the dishwasher. It is also very common for people with ongoing low back problems to become sad or depressed. All of these things start to affect how people move and think, which can make the pain harder to overcome.
The International Association for the Study of Pain notes that “psychological and social factors not only affect back pain itself but also how much the pain impacts on a person’s life”. They say it is important to note that behaviours like avoiding particular movements or activities may be helpful in the acute stages of pain but often prolong pain in the long term. They also note that low self-confidence to perform activities that make up normal daily function or to exercise safely, is a big contributor to pain becoming recalcitrant and to pain affecting work, social responsibilities and recreation.
We know that active rather than passive treatments are much more likely to be successful in the long term for managing chronic low back pain. Active treatments are things that you can do yourself or with a little help from someone, such as exercise and learning about your pain. There are so many things you can try, and most people will be able to tell you what worked, or didn’t work, for them, but it can be hard to sift through the options to work out what might be best for you.
When it comes to chronic low back pain, or pain that lasts for more than 12 weeks, most guidelines suggest a combination of approaches to help both your body and your mind. Most guidelines suggest you should:
- keep moving as normally as you can
- keep up with your usual daily activities and modify them if you need to
- avoid going to bed for prolonged periods of time
- try a hot pack or warm shower for muscle aches and pains
- try to stick to any exercises or stretches that you may have been given by your treating therapist or doctor
- stay as physically active as you can
- seek some professional help if you have new symptoms or are feeling down or overwhelmed by your pain.
So how are you supposed to work out what will work for you?
New research at the Charles Perkins Centre Musculoskeletal Research Hub at the University of Sydney has been published in the British Medical Journal and sheds some light on what might work best for you.
Lead researcher and physiotherapist Emma Ho said she had often pondered over the best advice or adjunct treatments to give her patients, in addition to exercise. She knew from abundant research that exercise and movement are crucial ingredients to keeping people well, healthy and functional, but she wanted to know what else she could incorporate into treatment to maximise patient benefits.
She says: “We know that psychological factors often play a key role in the development of chronic pain as well as in its successful management, but we didn’t really know which of the available psychological approaches should be incorporated into treatment.”
Ms Ho and her team analysed 97 randomised controlled trials to compare different psychological therapies that may be combined with exercise-based treatment for managing chronic low back pain. At the end of a very long process, they found some very interesting results.
For people with ongoing non-specific low back pain, it seems the best treatments focus on both their bodies and their minds.
For people who suffer with pain that affects their ability to function day-to-day, moving more and exercising safely, as well as learning more about what their pain means, is the best combination of treatments to improve their function. For people who are more focused on improving their pain levels, it seems that in addition to movement and exercise, adding behavioural therapy might be the right path to follow.
Examples of behavioural therapy included graded exposure, where patients progressively increased their engagement in activities that they feared or practising progressive muscle relaxation techniques.
Many professionals can help you to move more and exercise safely. You may prefer to seek advice from your physiotherapist, chiropractor, exercise physiologist or GP. There are also lots of avenues to seek help for the brain piece of the puzzle. There are professionals such as psychologists and psychotherapists, as well as apps and courses that you can do.
The research shows that combining treatments for both your body and the mind leads to the best health outcomes. Just make sure you are getting good quality advice from people who are trained to help people with chronic pain.
At the end of the day, when it comes to chronic low back pain, it seems that you need to give both your body and your brain a little nudge in the right direction.
Read the BMJ article here and if you have new symptoms or are feeling overwhelmed by your pain, make sure to seek professional help.
Kate Roberts is an experienced physiotherapist and PhD candidate at the University of Sydney. She has a passion for helping older Australians manage their aches and pains.
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