A series of articles about low back pain attracted a fair amount of attention in the media this week. The series, published by the Lancet Journal, is a thorough review of low back pain’s causes and the efficacy of common treatments. Succinctly put, the causes of low back pain are ambiguous and the most oft prescribed medical treatments frequently don’t work.
The Causes Of Low Back Pain Are Unclear
Many of the standard treatments prescribed for low back pain fail. In fact, they often make the situation worse! That may sound shocking, but only until you learn that the causes of low back pain are unclear. Take disc herniations, for example. While nearly everyone has known or heard of someone who suffered pain from a ‘slipped-disc’, the Lancet Journal Series states that “there is no widely accepted reference standard for discogenic pain.” This is because discs cannot be directly linked to symptoms. It is well documented, for example, that disc herniations are often present in people that are not experiencing any discomfort at all. Further, herniations “often resolve or disappear over time independent of resolution of pain.” Arthritis fairs no better under scrutiny. The famous Framingham Study was unable to show a link between arthritis of the spine and the presence of discomfort.
So what accounts for all these bad backs? There are a few conditions that can be a direct cause such as tumors, fractures, or infections. However, according to the article, these are uncommon. More often, “low back pain is a complex condition with multiple contributors to both the pain and the associated disability including psychological factors, social factors, biophysical factors, comorbidities, and pain-processing mechanisms.” In other words, it is best understood as the possible result of one or many risk factors. This is similar to how we view cancer. While we know that something like smoking is a risk (a significant one!), it is not technically correct to call it a cause because it does not always lead to the disease.
The Psychological Component
One of the more important points of the Lancet Journal Series in that low back pain has a psychological component. Studies from the UK and Canada have found that mental distress as well as depression raise the risk for future low back pain. Even more interestingly, people’s belief in their ability to control the outcome – known as pain self-efficacy – may be more important than removing their fear or unhappiness surrounding their condition. Put another way, it is critical for people to know that they can and should take active steps to make things better, rather than wait around for it to go away.
What To Do About Low Back Pain?
So how are we to deal with this common yet mysterious condition? First of all, it is important to rule out those potential causes that are definitely linked to low back pain – tumors, fractures, or infections. A visit to your general practitioner should be your first stop, because they will be able to help you identify whether any of those things are a consideration that need exploration.
After that, the Lancet Series recommends something that will come as no surprise – get moving. This is true in a general sense, as in you need to be active, walking around, not spending too much time sitting, as well as in a specific sense; regular exercise with high quality movement is important. It may also be important for those who have had long term low back pain to consider the psychological aspect. What are your beliefs about your pain? Is fear of the issue holding you back from doing the very things that might help?
Finally, if your journey does eventually lead to specialized approaches such as imaging, ask questions. Is this image likely to lead to a change in my treatment? Is there evidence that the proposed change is actually effective? Is there something else I should/could try first?