By Dr. Bhavan Bhavsar (www.bhavanbhavsar.com)
Almost everybody will experience low back pain at some point as it is part of everyday life like getting tired, feeling sad or getting a cold.
While some episodes of low back pain can be severe and frightening, most people recover from the episode reasonably quickly and often without the need to see a health professional for treatment.
Pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. One should understand the new definition of pain which is recently revised by IASP which concludes that it is not necessary to have tissue damage to have pain.
Let’s look back at history and see where the terminology pain popularizes from. During the world war, medicos receive soldiers with complaints of extreme pain as the nails poking in feet but unfortunately while assessing, the nail never crosses the shoes to hurt the feet.
From their perspective pain cannot always be from our damaged tissues. Low back pain is highly prevalent and places a considerable burden on individuals, their families, and communities globally.
Clinicians and researchers addressing back pain should be aware of the cultural, social, and political context of back pain patients and how this context can influence pain perception, disability, and health care use.
Person’s presented dysfunctional beliefs associated with the intensity of pain, anxiety, depression and mainly disability, with a probable influence on the treatment. Thus, it requires targeted interventions and specialized educational programs for every subject with low back pain.
Let’s talk about posture, which fashionable terminology used these days to mimic the businesses. Posture is less about how we look and more about how we feel. Everyone’s body is different, so a one size fits all pose probably isn’t going to help you.
Many of the recent evidence also suggests that posture is not always correlated with imposed pain. So, standing, sitting or any particular act of action is highly individual and poorly reproducible thus one should not fight for one posture strategy for management of particular pain.
Pain is giving away message to our body to protect breaking it away. Most of the pain happens when we do something abruptly or do something for too long without preparing our body for the same.
Similarly, the medicines we call “painkillers” are not very effective at treating low back pain and often come with significant side-effects. Paracetamol, anti-inflammatories and even opioid medicines are not better than a dummy pill in studies of low back pain.
They do not speed up your recovery and have greater potential for harm. Most importantly, pain medicines shouldn’t be used as a standalone treatment nor as a long-term solution. Most people believe that an x-ray or MRI will identify the cause of their low back pain and lead to a better treatment plan.
However, strong evidence shows that rare and serious disease is present in only approximately one per cent of people with low back pain and a scan is only essential if it is suspected that the person is in this small group. Furthermore, a clinician should be able to identify signs and symptoms which suggest serious illness.
Critically, usage of scans can lead to worse, not better, outcomes when used too frequently. Invasive treatment like surgery is rarely an option for mechanical low back pain. Almost all international guidelines recommend it be avoided for a considerable period to allow adequate time for either natural recovery or recovery using non-surgical approaches, like exercise.
Unfortunately, many people are sent for surgeries too quickly which involve more cost, more risk and importantly do not seem to improve outcomes. Our body works as a chain perspective and is made to move dynamically.
Most of the time low back pain individuals are told to rest or so call bed rest for a few weeks and discouraged to do normal mobility which is again not correct as per the recent evidence.
A person with low back pain without red flags or profound pathology are encouraged to do purposeful movements to prevent deconditioning and protective stiffness. Profound rehab professional can guide you to teach profound movements to get rid of this.
While most of the low back pain individuals are looking for physical ailments of health, professionals forget to deal with motivational-affective and cognitive factors which are at most important as mentioned by Melzalk & Wall who have coined the pain gate theory back in 1965.
We rarely feel pain when we are happy. Perception of pain is again vital in pain management and yes, our thoughts impact our recovery from pain. how one interrupt pain can be vital upon how soon one gets the outcome.
Understanding of real causes of pain is also important to formulate the profound pain management guidelines. Health professionals also need to teach this concept to the clients for their better outcome.
The other way of expressing this is by saying that pain describes the way we experience something, not what is experienced. For example, we say that a tooth is aching, but the ache is not the property of the tooth but is our way of experiencing or perceiving the tooth.
Pain is not an intrinsic quality of raw sensation; it is a way of perceiving an experience. At last, people with low back pain should not rush into a cycle of overtreatment, once they are happy that they are like most people who get low back pain on and off which isn’t driven by a serious disease.
Lastly, one should be educated well about the real facts, assess the real causes of pain, teach how to interrupt pain better, stick to purposeful movements and specificity of rehab management can lead to early and longterm care.
The writer is a globally trained specialized physical therapist working at M.P. Shah Hospital, Nairobi dealing with newest evidenced-based approaches of pain management.