Surgery for back pain is now the last resort once all other avenues have been exhausted
On Saturday 1st February I attended the 3rd annual spinal symposium in London. Speaking were consultant neurosurgeons who deal with spinal conditions covering low back, neck and childhood conditions. In the audience were a group of about 170 people made up of physiotherapists, osteopaths and chiropractors.
I was pleasantly surprised to hear of the importance these neurosurgeons placed on the work we physical therapists did in helping patients stay off the operating table and aid rehabilitation afterwards. They were keen to stress that surgery is now the last resort once all other avenues were exhausted. Their hierarchy of back pain management is as follows;
- Self help
- Physical therapy – chiropractic/osteopathy/physiotherapy or acupuncture
- Analgesics – pain killers
- CBT (cognitive behavioural therapy)/Surgery.
Interesting to see analgesics comes after physical therapy. This is more often not the case in my experience. Also interesting to see CBT there alongside surgery.
The National Institute of Clinical Excellence (NICE) has outlined the parameters by which back pain is categorised. Acute pain is less than 6 weeks, subacute 6 weeks to 1 year and chronic 1 year or longer. Research has shown of those who suffer acute back pain 30% will go on to have chronic back pain and of the chronic group 10% have surgery.
Risk factors that contribute to low back pain are obesity, lack of exercise, history of smoking, repetitive lifting/twisting, low economic status and depression/anxiety. Smoking affects blood supply to the disc which contributes to degeneration and those who have regular exercise are less likely to experience low back pain. There was emphasis placed upon developing core muscle strength as in pilates.
There has been a bit of media hype about the use of antibiotics for chronic low back pain suffers. One of the consultants Mr David Bell has tried using antibiotics for chronic low back pain with a group of patients with no success at all and a lot of these patients suffered digestive side effects to the medication. He said the original research study was very small and more research needs to be done in area.
I left the symposium with mixed feelings. Yes it is good there is an openness and willingness to work together for the good of suffers of back pain and because of this the future may be brighter. On the down side, the reality is we are still stuck in a cycle of medication over treatment and any hands on help is often too little too late.