When a patient tells me they have read something in the newspaper about back pain my heart sinks and my left eye starts to involuntarily twitch as usually its some ill-informed garbage about a quick fix, or drivel about a miracle cure that I have to try and convince them is utter bull shit. But from this week there is hope that a patient has at last actually read something useful about their back pain in the media.
This week The Lancet published three very important papers about back pain. These papers authored by the worlds leading researchers highlight how back pain is a huge global burden affecting millions if not billions of people worldwide, and how it is getting worse despite advances in healthcare, medicine and surgery. Please go and read these papers here, they are freely accessible and well worth an hour of your time.
These articles highlight how back pain is often grossly mismanaged and over treated with many ineffective and dangerous treatments such as surgery, injections, and medications, but also how the less harmful but equally ineffective low-value treatments such as manipulations, massage, and acupuncture are wasting time and resources for patients and healthcare providers alike.
There has been huge interest in the media across the globe in these papers with all the major newspapers such as in the UK the Guardian, the Telegraph, and even the shitty Daily Mail running articles on it. Also, the tv channels such as The BBC have been running stories on it, and for once the media are doing a fairly good job in sticking to the facts, mostly, and sensibly reporting the findings thanks to the great work of the authors of these papers.
This is really encouraging as hopefully, at last, a lot of patients with back pain as well as the general public will read these and get some rationale sensible information about back pain. Simply put all these articles are challenging the way most view, approach and manage back pain and about time.
These articles ask us to recognise that back pain is a normal part of life and most episodes are not serious and don’t need any formal treatment. They tell us that low back pain is a complex condition caused by a multitude of factors, both mechanical, environmental, and psychological, but just because its complex it doesn’t mean its management needs to be complicated… Complex doesn’t have to be complicated… now, where have I heard that before?
These articles tell us that most episodes of back pain are self-resolving and don’t need time off work, don’t need painkillers, don’t need manipulation or acupuncture, and most certainly don’t need surgery or injections. Instead what they tell us is back pain needs to be effectively and efficiently screened for the rare but serious causes and then managed with reassurance and advice to keep active and positive.
This is music to my ears as it’s something I and many others have been trying to promote for years in trying to move clinicians away from overtreating back pain, in fact, all pain. However, not treating back pain doesn’t mean do nothing and don’t help.
Many people with back pain will still need help and assistance, but this is often just good simple, clear, honest, advice, education, and reassurance, which is undervalued by clinicians and patients alike, and often considered as doing nothing but really is doing a lot.
However, there are many barriers to ‘only’ giving advice and education, the first and most important is the financial reimbursement for ‘not treating’ people in pain. Unfortunately, in most private and even some public sectors, many clinicians get rewarded for doing things to patients and not just for their time and advice. This incentivises the clinician to over treat and until this changes, nothing else will. High fees for injections, surgery, specialist massage, manipulations and machines need to be eradicated, and flat fees for consultation time regardless of treatment need to be established.
The next barrier will be to get healthcare professionals comfortable and confident ‘not treating’ those in pain. Most who work in healthcare are caring empathetic individuals who want to help others in pain and distress, and so the desire to do something is strong, and the more desperate the patient the more likely the clinician will intervene. Desperate patients, unfortunately, create desperate clinicians.
The other significant barrier to ‘not treating’ will be to get patients to accept that ‘no treatment’ is in their best interests. Most patients see ‘no treatment’ as lazy, cheap, and uncaring and this can drive them to seek others, usually the quacks and charlatans who will give them what they want. Therefore we have to be very very careful in how we word, frame and do ‘nothing’ to avoid driving our patients into the waiting arms of these shysters.
Often for me, the key factor here is developing good rapport and trust with your patient quickly. The stronger this is, the more likely they are to accept your advice and ‘no treatment’ and this is why I am so passionate about getting more clinicians to recognise that it’s not WHAT they do that really matters but HOW.
So there you go some good news in the media about back pain at last. I’m positive that this will help the general public as well as us clinicians to promote a more evidenced-based, rationale, simple, and effective way forward for back pain. But don’t be fooled into thinking it will be easy or simple, it won’t, it will be challenging and difficult but that’s why we continue to do what we do hey!!!
As always thanks for reading…