Rethinking what's best for low back pain
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What is the current state of low‑back pain treatment in Australia?
Hello and welcome to the Health Report with me Norman Swan. Today a special feature on low back pain.
And I was looking for examples from the group and someone yelled out
orgasm. Oh yes. Oh yes right.
Well, that might be one antidote for some people now that codeine is no longer available off the shelf. But back pain is one of the most disabling conditions in terms of cost, lifestyle and work constraints. But the health system's response, the evidence is showing, is skewed. Expensive and potentially risky treatments such as surgery and cortisone injections are overused. And cheap and effective care is underused when there are new ways of thinking about dealing with back pain more safely. It's about movement. and retraining the brain. To bring you the latest, Anne Arnold has been on the road for the health report.
Those squeals you hear belong to an otherwise sensible physiotherapist who's being attacked by killer robots in a park beside the North Wollongong Surf Club.
Help us! When they fly at you, they're so real.
Deirdre McGee is playing a virtual reality game. She's meant to be shooting the robots. It seems she's losing.
Robots are flying at you. Yeah, they like hit you in the face. The robots come
at you. You need to pick up more guns. So drop those ones and pick up the next ones. Yep, and the left one. Good, well done.
Deidre's holding two remote control devices and pressing their buttons. But in her virtual world, she thinks she's holding guns and pulling triggers.
I can see my hand, but it's not in my body.
She's getting a glimpse of how the mind can be manipulated to change perceptions of the body and therefore, potentially, of
pain.
It was part of a pain revolution tour of regional New South Wales. A bunch of researchers and clinicians educating the public and local health professionals about new approaches to pain. Cutting-edge brain research is just one of the options that might help deal with the perennial problem of lower back pain.
What drove this series of papers in The Lancet was primarily the fact that low back pain doesn't seem to get the attention of a lot of other conditions, but we know it's actually the number one cause of disability around the world.
Associate Professor Mark Hancock was one of 30 international authors of a major Lancet series on lower back pain published recently.
We had a feeling from some of the literature that had been published that a lot of people were receiving the wrong types of treatments, the treatments that aren't recommended in guidelines, and that's very much one of the strong findings from the series of papers.
Australia fits
a pattern the researchers found throughout the developed world. The best examples of treatments that seem to be being used excessively and are potentially dangerous include things like spinal surgery, particularly complex fusion surgeries, spinal injections and also the use of opioids. So these all carry quite significant risks of harm and again there's not strong evidence of these being highly effective interventions.
Not for any forms of lower back pain?
That's a great question. For some forms of back pain, they are appropriate.
Why are spinal surgeries and cortisone injections considered over‑used and risky?
In very limited cases, though, and at the moment, they're being very, very widely used.
Exceptions that might require major interventions include fractures and tumours. But in Australia, for non-cancer back pain, spinal fusion surgeries rocketed up by nearly 170% in the nine years to 2006, according to a study published in the Australian and New Zealand Journal of Surgery. In the study, the operations were almost entirely in the private sector, and the authors suggested the rise was attributable in part to over-servicing.
You can never consider surgery as your best option. It is never your best option because an intact spine is always better than a surgically altered spine. My name is Katherine Jacobson-Raymond, and I am the author of Crooked, Outwitting the Back Pain Industry and Getting on the Road to Recovery, which was published by HarperCollins in May of 2017. The very title itself, The Back Industry, why is
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Chapters
8 chapters
1
What is the current state of low‑back pain treatment in Australia?
0:00–3:17
2
Why are spinal surgeries and cortisone injections considered over‑used and risky?
3:17–8:23
3
How does virtual‑reality research reveal the brain’s role in pain perception?
8:23–11:32
4
What does the “pain‑as‑protective‑signal” model mean for patients?
11:32–15:19
5
Why can imaging findings often fail to explain a person’s back pain?
15:19–18:09
6
How should clinicians balance brain‑focused and local‑tissue approaches?
18:09–20:48
7
What policy changes are suggested to fund safe, low‑cost back‑pain care?
20:48–24:24
8
What practical steps can listeners take to stay active despite back pain?
24:24–28:19
Speakers
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