Many cases reported in outpatient clinics are related to low back pain. According to the WHO, it is estimated that by 2050, around 843 million people will suffer from low back pain. Among them, at least 90% of the cases involve chronic primary or non-specific low back pain.
Low back pain is a burdensome condition for many young adults, as the condition can lead to a downward spiral of long periods of pain that substantially increases over time. Not all people suffer from chronic low back pain, but 5% to 10% of acute low back pain turns into chronic pain if not treated promptly.
Several factors cause primary and secondary low back pain, including psychological, biological (secondary to systemic or musculoskeletal disease) and environmental factors.
Chronic low back pain (>12 weeks) significantly affects the quality of life; people tend to reduce social gatherings, limit instrumental activities of daily living (IADLS), and are only able to perform basic activities of daily living (ADLs). This also reduces optimal output in terms of work and family.
Low back pain majorly affects the geriatric population. However, a significant increase is being observed in young women and middle and older young adults.
The WHO has released guidelines on managing chronic low back pain and emphasised that healthcare systems should rigorously follow them in daily practice. The main components of these guidelines are as follows:
Patient education is crucial in addressing the cause of low back pain. GPs and physical therapists should guide patients about the nature of back pain and ways patients can prevent reoccurrence so that they can stay active in life.
It is imperative to use a patient-centred approach for effective shared decision-making. The GP should provide patients with multiple treatment options and guide them to choose the best option to treat the condition. They can opt for educational booklets/ leaflets, telehealth consultation services and digital eBooks.
Physical therapy is the foremost conservative treatment option for almost all cases of acute and chronic low back pain. It is recommended for pre-op and post-op patients as well. The physical therapist will carefully assess the patient's condition to devise a personalised, patient-centred exercise program.
The patient is given an exercise plan and posture corrective exercises. A home exercise program is suggested to be incorporated into the daily routine to prevent reoccurrence.
Psychological factors play a significant role in causing non-specific low back pain. Chronic low back pain is the most common complaint reported by workers. Workers who are exposed to the following psychological factors are highly susceptible to chronic sustained low back pain:
GPs should be alert to psychological factors. They can adopt a psychotherapeutic approach (being empathetic and reassuring towards the patient to help eliminate concerns) to enhance trust and improve doctor-patient relationships.
A new therapeutic approach, cognitive behavioral therapy, can help change negative thoughts and has shown favourable results in improving painful, disabling musculoskeletal conditions.
Many patients resort to painkillers to get through the day. However, patients often fail to understand that specific dosages are essential to reduce pain and prevent drug toxicity. GPs primarily prescribe non-steroidal anti-inflammatory drugs or paracetamol in combination with opioids and ibuprofen.
However, patients who are suffering from psychological back pain may require antidepressants and anticonvulsants to reduce painful symptoms. Some patients might have sudden acute onset back pain due to heavy weight lifting, and it could be discogenic pain or related to underlying systemic disease.
Pain is subjective in nature and can be triggered by multiple causes. In patients with low back pain, pain relief is the foremost concern for GPs. A multidisciplinary and multimodal rehabilitation approach is best for long-term treatment.
- Dr Humda, Physiotherapist
Learn more about this topic in the HealthCert Professional Diploma program in Musculoskeletal & Sports Medicine - fully online or with optional practical workshops.
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