Probably the most frequent disability we see in our practice is spine pain.
Although this story focuses on low back pain much of it is true for neck pain as well. Not all doctors treat this type of pain well. Chronic pain is debilitating to people, and many doctors get frustrated at not being able to offer much. It doesn’t help when insurance companies get in the way. Not only do they not want to pay the medical care, but they are concerned about getting the injured worker off of time loss (wage replacement). This often leads to delay in medical care and reliance on opioids. In any event, this is an interesting read.
~Chris Moore
Ineffective Treatment Often Prescribed For Lower Back Pain, Report Says!
RINA SHAIKH-LESKO
NPR News
Chances are, you — or someone you know — has suffered from lower back pain.
It can be debilitating. It’s a leading cause of disability globally.
And the number of people with the often-chronic condition is likely to increase.
This warning comes via a series of articles published in the medical journal Lancet in March. They state that about 540 million people have lower back pain — and they predict that the number will jump as the world’s population ages and as populations in lower- and middle-income countries move to urban centers and adopt more sedentary lives.
“We don’t think about [back pain] the same way as cancer or heart attacks. But if you look at disability it causes, especially in middle- and low-income where there isn’t a safety net, it impacts half a billion people,” says Roger Chou, a physician who is a pain specialist at the Oregon Health and Science University and a co-author of the articles.
Disability from chronic back pain can hurt a person’s ability to earn a living. One of the Lancet studies found that among rural Nigerian farmers, half reduced their workload because of back pain — an example of how the disability could contribute to the cycle of poverty in countries that lack benefits such as sick days or a social safety net.
Another study from Australia found that people who retired early because of back pain potentially lost out on hundreds of thousands of dollars of accumulated wealth when compared with healthy people who worked all the way to 65.
An overarching issue with back pain management is that the treatments doctors prescribe are often the wrong ones, the report concludes. Also, in many low-income countries, accessing health care is challenging — and getting appropriate care of back pain, specifically, is even harder. In some poor parts of Asia, pain medications are hard to come by and doctors may not have been trained on the most effective treatments.
For most people with back pain, guidelines developed by pain management specialists at the American Pain Society and the American College of Physicians recommend staying active, using cognitive behavioral therapy and techniques like focused breathing, and getting regular exercise. But doctors are more likely to recommend rest, decreased physical activity and treatments such as surgery or injections.
Why the disparity?
Lack of awareness among both the general public and doctors who are not pain management specialists is a big reason. Another reason many doctors aren’t following the guidelines is because, in countries like the U.S., surgeries, injections and medications, like opioids, tend to be better covered by insurance than psychological interventions like cognitive behavioral therapy or patient training.
“Our understanding of what causes low back pain is very limited. We have very little knowledge about what exactly is causing the pain,” says Andrea Furlan, a pain researcher at the Institute of Work and Health in Toronto and a pain management physician at the University of Toronto School of Medicine.
