I read an interesting article yesterday about how many prescribed treatments for low back pain and ineffective and even detrimental. The article from NPR, can be found here:
The article points out three interesting things: 1) low back pain is very prevalent and is one of the main causes of disability for people all over the world; 2) this disability costs individuals more depending upon their economic circumstances going into the health problem; if you are just getting by then having your low back become injured can devastate your ability to earn income and maintain your economic status; and, 3) low back pain is not always very well understood by doctors who treat it as they are not pain specialists and the prescribed treatments are often not only ineffective, but detrimental.
An interesting section of the article reads:
“For chronic back pain, ineffective therapies are used way too often, and things that are shown to work are significantly underused,” says study co-author Judith Turner, a clinical psychologist specializing in pain management at the University of Washington School of Medicine.
For most people with back pain, guidelines developed by pain management specialists at the American Pain Society and the American College of Physicians recommend staying active, using cognitive behavioral therapy and techniques like focused breathing, and getting regular exercise. But doctors are more likely to recommend rest, decreased physical activity and treatments such as surgery or injections.
Why the disparity?
Lack of awareness among both the general public and doctors who are not pain management specialists is a big reason. Another reason many doctors aren’t following the guidelines is because, in countries like the U.S., surgeries, injections and medications like opioids, tend to be better covered by insurance than psychological interventions like cognitive behavioral therapy or patient training.
“Our understanding of what causes low back pain is very limited. We have very little knowledge about what exactly is causing the pain,” says Andrea Furlan, a pain researcher at the Institute of Work and Health in Toronto and a pain management physician at the University of Toronto School of Medicine.
A complex matrix of factors is implicated in back pain including genetics, social and psychological causes, and chronic conditions like obesity, smoking and insomnia. Treatments such as surgery, injections and opioids only address a narrow subset of those factors. It has been difficult for researchers to tease out how those causal factors interact, so the ability to treat back pain is still rudimentary.
Pain management doctors and researchers say they would like to see a shift toward evidence-based treatments that recent guidelines recommend — emphasizing nonpharmacological treatments for most patients.
At Wiener & Lambka, PS, we have represented many clients who have low back injuries. Staying abreast of the medical developments and insights about these injuries is an important aspect of what we do to try to provide the best service to our clients. Part of this service is talking with our clients about their symptoms and problems and trying to help make sure that they are pursuing care that will help them to make a full physical recovery.
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