Factors To Consider In The Treatment Of Chronic Low Back Pain

Low back pain continues to be a topical issue within society and one which all of us can relate to. Undoubtedly each of us have either suffered with low back pain ourselves or know someone who does.

While for some it can be an acute episode that resolves over a short period of time for others it becomes an ongoing issue that may develop into a much greater problem, that of chronic low back pain.

We recently listened to a very interesting podcast by Dr. Kieran O’Sullivan, from the University of Limerick, on chronic low back pain. He discusses how we as Chartered Physiotherapists can improve our approach in the care of these patients suffering low back pain.

Some highlights from the podcast include:

By the time someone with chronic (around 3 months or more) low back pain attends the physiotherapist he or she may already have been in contact with several healthcare practitioners and undergone extensive diagnostic testing. Each of these practitioners may have had a slightly different explanation as to the cause of this person’s pain.

Medical practitioners including physiotherapists need to be aware that we can be very influential in how the patient understands the condition by the type of descriptive language we use. It is important to avoid using threatening or sinister sounding terms like ‘a blown disc’ because more often than not these terms are not accurate descriptions of what is really happening at a structural and physiological level. Furthermore these harsh sounding terms can cause excess worry and concern which in turn can have a real impact on pain levels, well being and function. When we as Physiotherapists explain the nature of pain and their particular problem it is important that we ask you to relay this information back to us as sometimes what we say and how this information can be interpreted can be very different.

As physiotherapists we need to be aware that we cannot treat chronic low back pain in the same way we would an acute episode of low back pain. At this stage the patient will not benefit from manual or ‘hands on’ therapy alone as this type of pain is not primarily a ‘mechanical’ problem simply caused by a stiff joint or tight muscle which needs ‘releasing’. A person’s belief and understanding of their problem as well as any associated fear, anxiety, stress, depression or social isolation are linked to a greater risk of ongoing chronicity in low back pain. Therefore chronic low back pain requires a multi-dimensional management approach which includes physical, lifestyle, cognitive and coping strategies. While there are benefits to ‘hands on’ therapy Dr. Kieran O’Sullivan makes the point that if the pain is chronic, it is is not primarily a mechanical issue and therefore perhaps less time should be spent on manual therapy and more on education and coping strategies. This enables the patient to become more self-reliant and will work towards empowering them in the management of their problem.

Chronic low back pain is a complex issue. Our understanding of the underlying physiological, psychosocial and behavioural elements continues to evolve as the evidence base into this area expands. As clinicians it is our responsibility to stay up to date with such research and learn to adapt as therapists in order to provide a holistic, appropriate approach to patient care.

By Paula Morgan.

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