The question of how to get rid of back pain has long plagued both the patient and medical community alike. Although we have learned much about back and neck pain over the last 25 years, back pain remains a medical enigma, leaving us, in some cases, with more questions than answers.
In this article, back pain recovery times are discussed in relation to nonspecific back pain.
Back Pain Recovery Time Unclear
According to professionals at the 7th EFIC Congress – Pain in Europe VII Hamburg, the prognosis for unspecific back pain which is already an epidemic in industrialized countries, has been worse than commonly recognized. This pain, which cannot be linked to any specific disease, needs further research and rehabilitation efforts if treatment methods are to be increased and enhanced. There is some hope that such efforts may develop.
(EFIC stands for European Federation of IASP® Chapters. A multidisciplinary professional organization in the field of pain research and medicine.)
Prof. Dr. Maarten van Kleef (Maastricht, NL) pointed out today at the 7th EFIC Congress in Hamburg that:
“Because 80 percent of patients on sick leave due to unspecific back pain resume work within a few weeks, there has been a broad misconception that they recover from their pain within this period. For a vast 65 percent majority, however, the sad truth is that back pain becomes chronic.
That causes a huge burden of personal suffering and a tremendous socioeconomic impact on society that is far from being sufficiently addressed. Recent studies and systematic reviews indicate that the prognosis of pain in a population of patients with low back pain is not at all favorable.
This unfavorable outcome is not yet common knowledge, not even for most primary care providers and decision makers in health care. We therefore have to increase efforts to disseminate information and to promote both prevention and more effective therapies. And not least of all, we need to design a new classification of unspecific back pain, breaking it down into appropriate subgroups to allow for the development of pinpointed treatments for each.”
Unspecific chronic back pain much more common than people think
Unlike specific back pain – that can be identified to an acknowledged diagnosis like infection, osteoporosis, cancer or vertebral fracture – unspecific back pain normally results from degenerative processes in one or more of the many sections of the human spine.
In industrialized nations over recent decades, back pain has become an epidemic. Around 60% to 90% of individuals will experience some kind of back pain at least once during their lifetime. Of that 30% to 50% will involve cervical pain, 16% to 20% thoracic pain and more than 70% lower back pain. Of these figures roughly 95% accounts for unspecific back pain. ?
A rehabilitation program can be as effective as surgery
Prof. van Kleef said:
“As befits such a serious theme, many scientific sessions and presentations at the current EFIC Congress discuss the problem of adequately treating back pain, adding to existing evidence for effective treatment options. In the area of pharmacology, only short term use of NSAIDs and weak opioids is recommended. Noradrenergic or noradrenergic-serotonergic antidepressants, muscle relaxants and capsicum plasters can be considered.”
The professionals explained:
“Multidisciplinary rehabilitation includes a combination of exercise, functional restoration and cognitive behavioral therapy. But we see that the effectiveness of such interventions is small to moderate when applied to the general population of back-pain patients.”
Caution is called for regarding minimally invasive interventions, such as the infiltration of corticosteroids directly into the spinal channel guided by computer-assisted fluoroscopic imaging. “Scientific evidence for these interventions is weak, but they can sometimes be effective for pain in highly selected patient groups.”
Prof. van Kleef said:
“Surgery for chronic back pain and cervical pain is based on the assumption that pain will stop once the symptomatic painful segments are immobilized by operative fusion. However, randomized studies comparing fusion with non surgical treatment indicate that a rehabilitation program can be as effective as surgery.
Therefore, spinal fusion and total disc replacement surgery should not be regarded as a standard treatment for chronic back pain. They should only be considered if at least 2 years of intensive conservative and minimal interventional pain treatment programs have failed to relieve the patients’ pain and disability.”
New classification crucial for better understanding
Prof. van Kleef explained:
“There is an astonishing deficiency both of understanding raging unspecific back pain and of adequate options for managing it. We urgently need nomenclature for classifying back pain beyond simply nonspecific.
Relevant subgroups are needed that describe the location and cause of the pain, like pain originating from disc disorders, pain originating from the degeneration of the small joints directing the movements of the spine, or pain originating from a degeneration of the sacroiliac joint. This would subdivide the vast and undifferentiated field of – nonspecific pain – into clinical phenomena based on the same pain mechanism that would probably require the same combination of treatments. We expect this to lead to more and better back pain research and consequently more pinpointed patient management strategies.”
European Week against Pain dedicated to chronic back pain
The European Week Against Pain (EWAP) starts on 10th October, 2011. One of the aims of the Plan for Action to fight Chronic Back Pain, to be presented at EFIC is a new and appropriate classification of back pain.
All over Europe, public awareness will be directed toward the negative natural course of back pain, the various methods for treating and preventing back pain and the why improved research is important into the different mechanisms generating back pain and disability.
Prof. van Kleef predicted:
“The Plan of Action should enable us to make remarkable progress, in only a few years, in our fight again st the most widespread pain disorder of our time. This is our responsibility to the innumerable individuals affected and to society as a whole.”
Source: Medical News Today
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