Whole of community pain education for back pain. Why does first-line care get almost no attention and what exactly are we waiting for?
Two articles on PainSci cite Moseley 2018: 1. The Complete Guide to Low Back Pain 2. Mind Over Pain
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.
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:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.