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Back Pain Research Review
Conclusions
While reviewing these conclusions it is important to keep in mind the
limited nature of the science behind the conclusions. A Level A Strong
evidence rating means that the findings concur in several, randomized
controlled trials of high quality.
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The other confidence levels are much less indicative of clearly actionable findings.
Level B Moderate evidence – findings concur in one randomized
controlled trial of high quality or one or more randomized controlled
trials of low quality, or findings concur in several studies of low
quality.
One study regardless of quality in the study of a multivariate,
objectively indeterminate condition compounded by psycho-sociological
influences is inadequate to draw significant conclusions from other than
viable avenues for additional study.
Level C Limited evidence – based on one randomized controlled trial (of high quality or low quality) or contradictory findings in several studies. This level is a clear indication of a need for further high quality studies.
Level D No evidence – no randomized controlled trials or other types of studies of satisfactory scientific quality.
In primary care, the consultation itself offers a major opportunity to influence both the acute and the more long-term course of back problems. An essential aspect of the consultation is the involvement of the caregiver and the ability to work with and listen to the patient’s perceptions on back pain, mainly how it impacts on daily life. The opportunity for the physician and the patient to arrive at a common understanding about the nature and course of back pain is of major importance for the prognosis and is highly dependent on a good patient-doctor relationship.
Pain in the low back and neck is common. Low back pain affects up to 80% of all people at some time during life, and neck pain affects up to 50% of the population. In the overwhelming majority of people, back pain does not signal a serious disease or suggest that one should avoid normal daily activities. On the contrary, scientific studies show that healing is promoted by staying active, returning to work, and exercising at an appropriate and increasing intensity.
- A thorough medical history and physical examination is important for relieving anxiety about the consequences of pain and sufficient for identifying the patients who should be referred to another specialist for examination and treatment (eg, due to severe infection, specific rheumatic disease, suspected cancer, or other serious conditions).
- For most people with back pain, the interventions which can be offered in primary care are the only ones needed. The physician’s attitude and ability to listen to and express empathy with the patient is important for achieving a common understanding with the patient concerning which treatment strategies would be effective. This also has importance for the future course of back pain and compliance with treatment advice.
- Back pain and its consequences are not isolated physical problems but are associated with other conditions such as social, psychological, and workplace-related factors. These factors, stress, worry, and anxiety – along with the patient’s own perceptions of and perceived ability to manage the problem – can be a determinative factor in if the pain transitions from acute to more chronic pain. The obvious role of psychosocial factors in this respect suggests that such factors should be considered an integral part of back pain in relation to conclusions preventive efforts, in the initial phase of treatment, and later during rehabilitation.
- Knowledge on how to prevent back pain has been applied and assessed to a surprisingly small degree. The knowledge currently available should be applied and thoroughly assessed.
- The relatively large resources that have been invested locally, regionally, and nationally to prevent and rehabilitate back problems, including interventions to improve the work environment, should be subject to systematic assessment based on current knowledge about the effects of various interventions. The sporadic research on prevention and rehabilitation of back problems should also be assessed in terms of its relevance and scientific quality
- .Many treatment methods are currently used, but there is little scientific evidence on their benefits. Some treatment methods are used despite scientific evidence showing that they do not benefit the patient. The appropriateness of subsidizing ineffective treatments with public funds should be investigated.
- The primary focus concerning back pain should be on the pain itself and on the human suffering it involves. Furthermore, back pain has an extensive economic impact on the individual and society. The direct healthcare costs and the costs resulting from sick leave and early retirement due to back pain reach an annual sum that is over three times higher than the corresponding costs for all cancer diseases.
Against this background, it is remarkable that research on back pain, particularly research related to prevention, pain relief, and rehabilitation is relatively limited in scope. Agencies which have responsibility for and interest in effectively managing back problems should take initiatives to stimulate and focus research in this field, and disseminate information that is currently available..
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