Before we get in to the details of this two-article series it is important that we seek some clarification around lower back pain and what it is. Critical to understanding lower back pain is to appreciate that it is a symptom and not a cause. By this we mean that lower back pain is a sign that something is not quite right, obviously, but that there is an underlying mechanical issue that is the cause of the pain. So when we are talking about lower back pain we are talking about something that is a symptom of a larger problem within the body and not a cause in and of itself. Think of stubbing your toe. The pain in your toe is a symptom that was caused by kicking the bed post as you walked by and resulting in a bruise or break of your toe.
So how prevalent is lower back pain? According to a recent piece of research published in the Lancet the worldwide prevalence was 7.4% of the population who suffer from activity-limiting lower back pain, with over 50% of people suffering from activity-limiting lower back pain at some point in their life. This means that their back pain was such that it stopped them from performing certain activities and impacted their quality of life. This is equal to 540 million people on the planet right now that are suffering from lower back pain, ensuring that Exercise Physiologists should have work for the next 540 lifetimes! Jokes aside, it is an astounding number and a true worldwide epidemic, being the number one cause of disability globally.
But what exactly is lower back pain? It is defined as pain that is located between the lower ribs and the creases of the buttocks. The pain is often very generalised with the pain not being able to be accurately described or located and this is called ‘non-specific lower back pain’. There are very serious causes of lower back pain and these include conditions such as malignancy, vertebral fracture, infection and various inflammatory disorders, however these conditions account for only a very small fraction of back pain complaints.
Very interestingly, it appears that people who suffer from lower back pain will often suffer from other comorbidities with the combination of these causing greater distress than lower back pain in isolation. Furthermore, lower back pain seems to be associated with mental health problems as well and other cognitive issues possibly related to pain perception. All of this means that treating back pain is far more complex and challenging than it had been thought, which validates the experience of many health practitioners including the ones at EP360.
The risk factors and triggers for bouts of lower back pain very comparable across the globe, irrespective of where you live or your socioeconomic status. The overwhelming majority of people that have suffered from one bout of lower back pain will suffer from another bout at some time in the future. Furthermore, people with other chronic conditions are much more likely to experience lower back pain than those that are of otherwise sound health.
One of the really interesting points to be taken from this huge study include the fact that it appears that people who suffer from poor mental health are at a very increased risk of suffering from lower back pain than those that are otherwise mentally healthy, including people suffering from depression, who are many times more likely to develop and experience a bout of lower back pain. Several lifestyle factors including smoking, obesity and low level of physical activity associated with poor health generally are also correlated very strongly with lower back pain. It has also become clear that work environments and tasks that require ‘awkward postures’ to perform a task are also an indicator for lower back pain. This includes heavy manual work, repetitive bending and distractions when lifting (meaning not concentrating on the task of lifting or bending). The actual causes of the back pain, when onset is under the above circumstances, is not clear, suggesting that the actual cause of the pain is not necessarily mechanical.
What does all of this mean? It means that the causes of back pain are complex and the cure is equally complicated. We are starting to see the application of a biopsychosocial approach to managing back pain which means that we are taking the biology, psychology, social and genetic factors surrounding a patient’s situation into account, rather than the straight application of the biomechanical model, which we now understand has not worked very well.
By far the most interesting aspect of all of the recent research are the psychological factors associated with back pain. There is a substantial overlap of constructs such as depression, anxiety, catastrophizing and self-efficacy. The presence of these factors in people who present with low back pain has been shown to increase the risk of developing disabling lower back pain, even though the mechanisms are not completely understood. The suggestion is that, therefore, when we are attempting to manage a client with disabling lower back pain we need to consider the role that counsellors and psychologists may play in helping our clients to get the best outcome.
Related to this is the fact that data now also shows that central pain processing and modulation are often altered in people with chronic disabling lower back pain. There is some evidence to show that people with this condition have structural brain differences in particular areas of the brain that are responsible for pain processing. This essentially means that some people will perceive and process pain differently than others and therefore influence the treatment and outcomes.
All of this is an introduction to the next series on back pain, however I hope that this first blog has laid the groundwork for you to better understand the processes outlined in the next post. Until then!
Yours in Health!