How Common is Back Pain?
Most of you will experience spinal pain at some point during your life time. In fact some research estimates that up to 90% of you will get low back pain (LBP), and 70% will get neck pain [i],[ii],[iii],[iv]. To put that into context, the last census recorded in 2001 showed a UK population of just under 59 million. This means that around 53 million of you will get back pain and around 41 million will get neck pain. That’s a lot of people! In fact low back is the most common reason that you visit your GP except for headaches and tiredness [v]. When we put it like that, you may look at the problem of spinal pain and its burden on you and the economy (£10,668 million per year [vi] in a new light.
Will It Get Better?
For a vast majority of you, yes, in fact most ’simple’ LBP [vii],[viii],[ix] and neck pain (not related to a whiplash injury [x] ) is thought to be self-limiting, settling within 4-12 weeks under its own steam. Unfortunately, this does leave somewhere between 3-10% of you, or up to 5.9 million who will go on to develop chronic low back pain,[xi],[xii] (same pain lasting for more than 3 months consecutively). Although this group is proportionally small, it accounts for nearly 50% of all resources allocated to the treatment of LBP [xiii]. The bottom line is, it is impossible to stop everyone from developing chronic LBP even in today’s age of medicine, and we need to accept this fact. What we can do however is strive to limit this occurrence where possible, and help those of you where it is not preventable to cope and manage your complaints in the best way possible.
An important part of this approach is the adoption of the ‘Biopsychosocial‘ model. This is supported and encouraged by most of the Health organisations in the developed world and recognises the importance of addressing any psychological and environmental aspects of your presentation as well as the physical. This DOES NOT mean that we think it is in your head, but simply that most of us will adapt our behaviour and thoughts towards normal everyday practices in response to our pain. This may range from something as simple as not sitting for too long in the evening to making a lengthy plan on how you will be able to get dressed in the morning. In response to this, nearly all spinal pain should aim to be treated with a rounded approach and should involve you, the patient in the leading role. There is a dedicated section on the biopsychosocial approach that can be found in the education header above and explains this in much more depth. Whether it is simple self management, professional rehabilitation or even surgery, you will need to be prepared to adopt a temporary or permanent change in your lifestyle to reach your full potential.
References [i] Waddell W. A new clinical model for the treatment of low back pain. Spine 1987; 12(7): 632-44 [ii] Kelsey JJ. Epidemiology of musculoskeletal disorders. New York: Oxford University Press, 1982 [iii] Biering-Sorensen F. A prospective study of low back pain in a general population: 1. Occurrence, recurrence, and etiology. Scand J Rehab Med 1983; 15: 71-9 [iv] Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain Cur Opin Rheum 2001; 13: 128-34 [v] Clinical Standards Advisory Group. Back pain: Report of a CSAG committee on back pain HMSO, 1994 [vi] Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000; 84: 95-103 [vii] Nachemson AL. The natural course of low back pain. In: White AA, Gordon SL. Eds. Symptoms of idiopathic low back pain. St Louis: Mo, Mosley, 1982; 46-52 [viii] Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ. Predicting who develops chronic low back pain in primary care: A prospective study. Brit Med J 1999; 19: 1662-7 [ix] Watson PJ. Psychosocial Assessment; The emergence of a new fashion, or a new tool in physiotherapy for muscular pain. Physiotherapy 1999; 85(10): 530-5 [x] A systematic review of conservative treatments for acute neck pain not due to Whiplash. Howard T. Vernon, DC, PhD,a B. Kim Humphreys, DC, PhD,b and Carol A. Hagino, MBA Journal of Manipulative and Physiological Therapeutics Treatment of Acute Neck Pain July/August 2005 [xi] Pengel LHM, Herbert RD, Maher CG, et al. Acute low back pain: Systematic review of its prognosis. BMJ 2003; 327: 323-5 [xii] Reid S, Haugh LD, Hazard RG, et al. Occupational low back pain: Recovery curves and factors associated with disability. J Occ Rehab 1997; 7: 1-14 [xiii] Nachemson A, Jonsson E. Neck and back pain: The scientific evidence of causes, diagnosis and treatment. Philadelphia: PA, Lippincott Williams & Wilkins, 2000; 495
