By Paul Yates
Discussed at the 7th EFIC Congress -- Pain in Europe VII in Hamburg concluded that the prognosis for unspecific back pain, already an epidemic in industrialised countries, has been worse than commonly recognized.
This unspecified lumbar pain, isn't attributed to a specific disease and needs an increase in research and rehabilitation support if recovery rates are to be improved. There is some optimism that the necessary support will be forthcoming.
Of the work force on sick leave due to unspecific back pain, 80% return to work within a few weeks, however there has been a broad misconception that they recover from their pain within the time taken off sick yet for upwards of 65 percent of this group, it is thought that the pain suffered eventually becomes chronic.
In essence the back or lumbar pain that we are talking about is having a major impact not just in terms of the personal pain) but also from a socio economic point of view and with most care inadequate, the prognosis is not good.
The discussion concluded that we must design a new classification of unspecific back pain, breaking it down into appropriate subgroups to allow for the development of pinpointed treatments for each.
During recent decades, back pain has become all the more common in the industrialised countries. Somewhere between 60 & 90 percent of the population will experience some kind of back pain at least once in their lifetime. Of that, 30 to 50 percent will involve cervical pain, 16 to 20 percent thoracic pain and over 70 percent lower back or lumbar pain. The unspecific element accounts for approximately 95 percent of these figures.
Because of the serious nature of the problem and the socio economic impacts, the current EFIC Congress has discussed the problem of adequately treating back pain in many of its sittings, contributing to current evidence for effective treatment options. The technical reports concluded that only short term use of NSAIDs and weak opioids is recommended. Noradrenergic or noradrenergic-serotonergic antidepressants, muscle relaxants and capsicum plasters can be considered.
The best forms of rehabilitation include a combination of exercise, functional restoration and cognitive behavioural therapy however it has to be said that present usage of such interventions is small to moderate when applied to the general population of sufferers of pain.
Scientific evidence for interventions such as the infiltration of corticosteroids directly into the spinal channel guided by computer-assisted fluoroscopic imaging is weak, but they can sometimes be effective for pain in highly selected patient groups.
Surgery for chronic back pain and cervical pain is based on the assumption that pain will stop once the symptomatic painful segments are immobilized by operative fusion. However, randomized studies have concluded that the non surgical treatment is just as valid if not better as a method of rehabilitation.
In conclusion, spinal fusion and total disc replacement surgery should not be regarded as a standard treatment for chronic back pain. Non interventional or natural cures for back pain should be considered and used for at least 2 years and medical intervention considered further only if treatment programs are found to have failed to relieve the patient's pain and disability.
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