Whole of community pain education for back pain. Why does first-line care get almost no attention and what exactly are we waiting for?
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
A recent series of back pain articles in The Lancet attracted a great deal of attention across the media, with the usual outrage at physios and doctors providing useless treatments, and the usual advice to sufferers to exercise and get psychological help. The authors—some of the most prolific back pain researchers on the planet—made a ‘call to action’ and it was a sensible one. But it was not really a new one—we have known for decades not to ‘take back pain lying down,’ that the vast majority of back pain episodes do not require surgery or long-term powerful analgesics, and that most will resolve over time if we do not mess them up. So how is it that we are still in this mire of spiralling costs and widespread disability?
When are we going to stop taking the very solid science and sensible calls to action just to see it mashed into an accusatory swing at doctors to clean up their act or sufferers to ‘get over it, change their mindset and exercise’?
Back pain is not a simple problem. There are many forces at play that propagate its widespread mismanagement. The massive elephant in the room—that entire professions appear to depend on the problem remaining unsolved—will be hard to tackle. In the meantime, the glar- ingly obvious cornerstone of best practice care that somehow keeps flying under the radar is education.
related content
- “Prevention and treatment of low back pain: evidence, challenges, and promising directions,” Foster, Nadine E and Anema, Johannes R and Cherkin, Dan and Chou, Roger and Cohen, Steven P and Gross, Douglas P and Ferreira, Paulo H and Fritz, Julie M and Koes, Bart W and Peul, Wilco and Turner, Judith A and Maher, Chris G and {Lancet Low Back Pain Series Working Group}, Lancet, 2018.
- “What low back pain is and why we need to pay attention,” Hartvigsen, Jan and Hancock, Mark J and Kongsted, Alice and Louw, Quinette and Ferreira, Manuela L and Genevay, Stéphane and Hoy, Damian and Karppinen, Jaro and Pransky, Glenn and Sieper, Joachim and Smeets, Rob J and Underwood, Martin and {Lancet Low Back Pain Series Working Group}, Lancet, 2018.
- “Low back pain: a call for action,” Buchbinder, Rachelle and van Tulder, Maurits and Öberg, Birgitta and Costa, Lucíola Menezes and Woolf, Anthony and Schoene, Mark and Croft, Peter and {Lancet Low Back Pain Series Working Group}, Lancet, 2018.
These two articles on PainScience.com cite Moseley 2018 as a source:
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Pain is Weird — Pain science reveals a volatile, misleading sensation that is often more than just a symptom, and sometimes worse than whatever started it
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
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- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.