Back pain, one of the major musculoskeletal pain problems, has plagued humans since we evolved the upright bipedal position from that of a quadruped. Waddell in his seminal book titled “The Back Pain Revolution” describes back pain as “The 20th. century medical disaster”.
All of us who treat patients with low back pain have first-hand experience of patients with a long history of chronic pain and disability. Many have had multiple treatments from alternative therapists, physiotherapists, drug therapy, talking therapies, injection therapies and surgery. If we examine the evidence closely and honestly, we see that there is a wide variation in outcomes varying from mild to moderate efficacy for some treatments that remain excluded by the NHS, while others have little or no evidence associated with them but remain as established treatments despite the evidence to the contrary (see Table 1).
Waddell describes back pain as “simply a mechanical disturbance of the musculoskeletal structures or function of the back. We cannot diagnose any specific pathology. We cannot even localise the source of most soft tissue pain. Some doctors and therapists do claim to be able to diagnose the site and nature of the lesion in many patients. However that tells us more about the health professional than about the patient’s back”.
Whether you agree with this statement or not, the fact remains that there are still patients turning up in chronic pain clinics with “failed back surgery” and close inspection of the patient’s extensive notes fails to provide an adequate diagnosis as to why surgery was performed in the first place.
This aim of this module is to give you an understanding of the treatment options for low back pain and the evidence that supports them. It also tries to address the often neglected ticking clock that begins when the person first bends down to tie up their shoelace and the importance that the right services are provided at the right time by the right person at the right place.