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A low back problem or a pain problem?

 •  • by Paul Ingraham
Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Fresh science, summarized for you today by Derek Griffin, PhD, and confirming one of my biases. The nugget:

People who are at risk of developing back pain are those who are at risk of developing pain in general. In other words, it appears that we are dealing with a pain problem, not a back problem.

And now the whole thing, from his Facebook post, about Coggon et al (open access):

A LOW BACK PROBLEM OR A PAIN PROBLEM?

Low back pain is common in occupational groups including nurses, office workers & manual workers. Much of the focus has been on the nature of the work i.e. the physical aspects of the job. The general assumption is that lifting, bending, sitting etc are the "drivers" of back pain in these groups. However there is now a significant amount of research that challenges this idea. Here is a recent paper from Prof David Coggon's group that looks at this issue. The paper highlights two important issues:

  1. Despite workers performing similar jobs, the prevalence of disabling low back pain varies greatly between different countries.
  2. People who experience disabling low back pain also report pain in multiple other body sites.
  3. Pain occurs together with other symptoms including diziness, nausea, chest pain, shortness of breath & hot/cold spells.

The findings are important. They suggest that people who are at risk of developing back pain are those who are at risk of developing pain in general. In other words, it appears that we are dealing with a pain problem, not a back problem.

I have often described back pain as a “tip of the iceberg” phenomenon, the back being the region of the body where the tip often shows up first and worst. The other classic hot spots are the neck and the guts. There are probably many problems with chronic pain in [insert body part] that don’t actually have much to do with that regional anatomy (maybe just a trigger), but more with a generalized vulnerability to pain.

The first time I ever thought about this, I think it was in the context of posturology. I realized that if someone is having trouble with relatively subtle postural stresses, the problem might be their vulnerability, not the stress. •mind blown•

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