Many health practitioners assume seeing an image of your spine will help explain the cause of back pain. According to Associate Professor Hancock, one of 30 international authors to work on the Lancet back pain series, this is not the case. While he acknowledges doctors are put under pressure from patients wanting to see a visual of their spine, Professor Hancock and his co-authors found widespread overuse of imaging to investigate back pain as a picture does not necessarily tell the whole story. He believes scans for simple lower back pain should not be subsidised by our health system as they are costly and their usefulness questionable. The reasoning behind this is as everyone’s spine changes over time. Muscles move bones so two people can have identical imaging yet one can feel no pain.
Cortisone injections
Associate Professor Hancock also believes cortisone injections are often offered as a universal remedy and their use has doubled, perhaps tripled, over a short period of time. These injections have become a very common intervention for people with sciatica. The Lancet researchers pulled together all the available literature on the injections — and again, there was little justification for cortisone injections.
“The best estimate we have from previous studies is that corticosteroid injections reduce sciatica (leg pain associated with back pain) by only five points on a 100-point scale compared to placebo in the short term, with no long term benefit, so it’s a very small difference” Associate Professor Hancock said.
No surgery … ever?
A reputable health professional Cathryn Jakobson Ramin researched what she calls the “back pain industry” and its surgical trends over the decades. Ms Ramin says “You can never consider surgery as your best option for ordinary low back pain because an intact spine is always better than a surgically altered spine. Problems emerged with each, and new techniques would take their place, but rarely with adequate evidence”
Professor Harris, an orthopaedic surgeon and author of the book titled Surgery – the Ultimate Placebo, agrees that surgery is rarely the best option for back pain. He says “For patients with typical degenerative changes in the spine and chronic low back pain without a significant neurological problem, I would not advise spine surgery in any situation. It is expensive and increases the risk of harm and there is no high-level evidence of a benefit.”
He also believes in the workers’ compensation system the impact is dire. Professor Harris says “We have previously shown that the results of this surgery in this group of patients is poor, with only 3% returning to pre-injury duties and about 89% still taking major narcotics for pain relief at 24 months post-surgery. The cost to the workers compensation system for this surgery is about $100,000 per procedure.”
Minimise the Use of Drugs
Back pain is the main reason people use opioids over a long period of time, according to the Lancet authors. However, the addictive harm of opioids has been well documented.
While Associate Professor Hancock said a short stint on anti-inflammatories may be helpful, medication shouldn’t be taken for a long period of time. “If a short period of anti-inflammatories helps get the person moving, then that’s appropriate, but with opioids, it’s a different story. With opioids we know that even very short periods of use increase the risk of dependence. Try to avoid them in almost all cases,” he said
Rethink your pain
Sometimes the very language we use to describe pain — “feels like a knife” and “there’s something burning in there” — contributes to the experience of pain. Drug advertising urges us to fight pain, attack it, and see it as an enemy.
The Pain Revolution movement, led by Professor Moseley, wants people to understand what the science indicates — that pain is a friend that protects our tissues when they need to heal, but it can get over-protective, because the brain is responding to all kinds of influences.
Professor Moseley said being aware of that has many benefits. The change of outlook and letting go of the fear allows people to gradually increase what movement they can do. We need to retrain our pain system including the body and brain. As well, varied and new experiences, of sight, smell, touch and creativity may reorient neural pathways and be helpful.
Find the right health practitioner
How do you make sure you’re on the path outlined above? It might not be easy, but try to find a GP, physiotherapist, Myopractor or chiropractor who is across current evidence.
There’s a strong view among pain researchers that not nearly enough is taught in medical school, or in other clinical courses, about the complexity of pain and the potential to influence it.
Associate Professor Hancock says “When it comes to the lower back, many Doctors are not keeping up with the guidelines. The old days of ordering bed rest are long gone, yet some clinicians still advise rest. If the clinician is recommending MRIs, investigations and injections, that should be a red flag to you as should if a clinician says see me three or four times”
Call Michael at MyBack Myopractic for an alternate way to treat the cause of your pain
Life is too short to be in pain! Regain your quality of life and avoid treating symptoms alone. Treat the problem and relieve yourself from lower back pain today. For more information or to make an appointment, call Michael from MyBack Myopractic Bunbury on 0438 339 001 today.
