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Will you treat someone with back pain?

How did you explain to them what their 'non specific low back pain' diagnosis means. I understand the 'medical' reason for this term, but hey, when you just look at the words, it is so 'No-Brand-Vanilla'.

How do I respond? A good question and I recently stumbled on what seemed a good analogy and will share it with you. Firstly however, I must stress that it is important to clarify they don't have a fracture, infection, inflammatory condition or tumor. This is an important part of our primary contact practitioner role. Back of the envelop calculations indicate, that if you see on average 3 new clients per day, and have 4 weeks holiday a year, you will be seeing on average 5 people a year that will be newly diagnosed with cancer in that year.

You will have been hard pressed not to have come across the three papers published March, in The Lancet, discussing the effectiveness of current assessment & treatments in regards to low back pain. If you haven't, then here is the direct link. In summary, there is much in common with other conditions, imaging over done, medication overdone, surgery over done and a greater role for encouragement, education and appropriate exercise/activity.

So, back to your discussion with your client about their non specific low back pain. I suggest we adopt a more useful phrase. Here we are mid winter and every tenth client comes in with the 'common cold'. About the same number of clients coming into our clinic with non specific low back pain. Not sure what is the prevalence of the common cold, but when a person has the common cold, they know they will get over it. Non specific low back pain has a one year prevalence just under 40% (Hoy et al. 2012) and rising (Hurwitz et al. 2018) and likewise, resolution occurs for the vast majority. Perhaps we should adopt the term 'common low back pain' instead of 'non specific low back pain'. Takes away the mystery, puts the experience into the regular and temporary basket and gives them a conversational label without too much baggage.

What are the reasons for picking up a common cold? Until our kids went to school, I thought it was exposure to a virus. However, on parent help days at primary school, I was always amazed that even when most of the classroom was down and suffering with the common cold, there were also kids that never succumb, and it was often the same kids time after time. Obviously not just due to exposure to a virus. How do people manage a cold? Based on the Chemist Warehouse ads bombarding SBS at the moment, it would seem a different way to how we managed them. Sleep, eat, drink water, rest up, low stress, fresh air and a bit of laughter (watching the chooks have sun baths is a guaranteed giggle). No one magic bullet, just implementing a range of positive lifestyle choices. No GP visits, no tests, no medications. My approach is much the same with common low back pain in the clinic.

Through conversation, I identify key lifestyle factors that may have left them vulnerable to catching the low back virus. Current and chronic stress levels, less than optimal sleep hygiene, not so healthy or appropriate nutrition choices, and lack of physical capacity/training for their chosen vocation and sport. Bit by bit through education, appropriate areas are discussed and more positive strategies are implemented. Sure it takes time, but changing any habit worth while takes time. In this role we are providing evidenced based care - education and self managed care.

Given the high reoccurrence rate of common low back pain, it is important that we educate and look beyond their current situation to longer term solutions. Not everyone wants to, but in the process of engaging with clients, some will be ready to take on the next step of greater self responsibility. I just love to paraphrase Einstein's definition of insanity - if you keep doing the same thing and expect a different outcome, that is insanity. Change brings about change.

However, the same quote applies to us as clinicians. If we want to assist clients to take self responsibility and get on top of their common low back pain experience, then through education and encouragement, we need to teach them the tools of self-management.

 

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