At any one time up to a quarter of adult Australians suffer from lower back pain. For most people, conservative treatments deliver a positive outcome.
They accept the discomfort, adopt a modified form of movement, and over time the pain dissipates.
However, for a smaller group of people the pain persists and over time, can become chronic.
Even then a conservative treatment plan can have powerful recuperative effects. In particular when it involves Cognitive Behaviour Therapy (CBT).
There is a growing body of evidence showing improved outcomes for patients with acute back pain when Cognitive Behaviour Therapy is aligned with physical therapies. [1]
In fact, there is some ground-breaking research using randomised clinical trials that showed patient outcomes for cognitive interventions were the same as for fusion surgery. [2]
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A lot of that lies within patient psychology.
Some people, through their own thought processes, magnify their perceptions of pain. They start to catastrophise the extent of the back pain, move into a cycle of fear avoidance.
They start to avoid movement and so the pain lingers – further reinforcing their fears.
For this group, both physical therapy and Cognitive Behaviour Therapy for back pain would be ideal.
The therapist makes a formal assessment of the psycho-social dimensions of pain as well as the physical, and then develops a treatment program addressing both.
Helps them start moving again, breaking down fear barriers, moving despite their illusion of pain.
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Yellow flags, red flags
To help medical practitioners distinguish between psycho-social and physical symptoms of pain, researchers at Keele University in the UK developed a simple diagnostic tool: STarT Back.
- Yellow flags – indicated a psycho-social dimension to their pain experience.
- Red flags – a physical cause – typically an indicator of a degenerative condition in the spine.
If your patient has red flags, please refer them to a specialist immediately. So that they can diagnose the cause of pain and develop an appropriate treatment program.
If you are uncertain, refer them anyway.
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[1] Management of people with acute lower back pain, ACI - NSW Agency for Clinical Innovation[2] Randomized Clinical Trial of Lumbar Instrumented Fusion and Cognitive Intervention and Exercises in Patients with Chronic Low Back Pain and Disc DegenerationJens Ivar Brox, MD, PhD,* Roger Sørensen, MD,* Astrid Friis, PT,* Øystein Nygaard, MD, PhD,† Aage Indahl, MD, PhD,‡ Anne Keller, MD,§ Tor Ingebrigtsen, MD, PhD, Hege R. Eriksen, PhD,¶ Inger Holm, PT,* Anne Kathrine Koller, PT,* Rolf Riise, MD,* and Olav Reikerås, MD*SPINE Volume 28, Number 17.
Posted 3 November 2021
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