*This article is written for the low back pain sufferer and the curious individual You may be one of the lucky ones to have never experienced any back pain in your life. If so, then you are the envy of many and can blithely read on. Why? Because back pain is seriously debilitating for its sufferers, so much so that some people talk about taking a sledge hammer to their spine to smash through the thumping pain. For chronic sufferers, every move you make can feel like somebody has a voodoo doll somewhere, quietly jabbing away at it with needles. It is, to put it simply, just dreadful, but what can you do about it? For those seasoned sufferers, popping pain killers just doesn't quite cut it (only masks the pain) and avoiding triggers (like sitting for a prolonged period of time) may only be enough to take the edge off a full blown attack. We know that the solution may not be as simple as a taking a drug or avoiding an activity in most cases, but requires a proactive approach to managing the condition, whether it be through a combination of exercise, rest, manual therapy, and/or counselling. The Lancet has spoken. Recently (as of March 22, 2018) in The Lancet (one of the world's oldest and best known medical journals), the medical community has been spurred on to wake up to the fact that back pain is a complex condition that needs to be recognised as such, and that socio-economic factors, including personal and cultural beliefs play a hugely important role in the pain experience (Clark and Horton, 2018). This does not come as a surprise to clinicians who specialise in treating back pain (i.e. osteopaths) or even to chronic sufferers. In a follow-up article on "What is low back pain and why we need to pay attention" , the authors state that low back pain is now the NUMBER ONE CAUSE OF GLOBAL DISABILITY (Hartvigsen et al, 2018). There are now several global initiatives seeking to address the global burden, but there is a NEED TO IDENTIFY COST-EFFECTIVE AND CONTEXT-SPECIFIC STRATEGIES for managing low back pain. This means that evidence needs to be gathered for these different strategies. You may (or may not) be surprised to hear that there is a lot of work done on gathering evidence for "opioid interventions" (drugs to you and me) and other medical procedures, such as surgery (as that is where the allopathic industry lies). However, there is already GOOD EVIDENCE for "advice to remain active" and "education" as first-line treatment strategies in acute low back pain, with "massage" and "spinal manipulation" as a second-line or adjunctive treatment option.** ** There was, however, no mention of osteopathy in any of the papers in the Lancet series on low back pain
So What? This long-overdue series by The Lancet on low back pain, has come as a vitalising clarion call that we, as osteopaths, manual therapists, and chronic sufferers, must take action on so as to get involved and be heard regarding our not insignificant knowledge, experiences and expectations in dealing with low back pain. Doctors and medics have long relegated the condition to be a passing thing, something that will eventually get better by itself (which in truth does for some) without any intervention (apart from pain killers, or in the extreme case, spinal surgery). Patients have been left frustrated, misinformed, and at worst misled into thinking they have something terrible that they have no control over it. Now, the allopathic medical community are waking up to this global burden and will be approaching it on a large scale public health initiative that could influence how we manage and treat back pain. This is a good thing, right? Well, it depends on what their approach will be. This could result in a crack down (excuse the pun) on non-evidenced based approaches (which is a topic of contention), or it could even be a push for more invasive interventions, such as surgical or therapeutic injections. If there is a push for manual-based therapies, then the physiotherapy profession will be the first to take up the banner of evidence-based practice. *** ***Although osteopaths are considered Allied Health Professionals, to those that may not understand the significance of this, osteopaths in the UK predominantly sit outside the National Health Service and are therefore not commonly the first port of call for physical therapy.
We must act! If the allopathic medical community cannot provide long term effective solutions, patients are left to seek all sorts of advice from whomever they trust, often via anecdotal evidence, for example ("My therapist is amazing, they gave me a days worth of relief from my pain, etc.") Whether this is how you end up finding your practitioner or how we end up seeing our patients, there needs to be a more formalised approach coming from doctors and the National Health Service (in the UK). We (as patients, clients, and practitioners) need to tell our doctors, nurses, and medical health care practitioners the benefits that come from seeking osteopathic treatment. If you are a patient or client that has benefited from osteopathy, please tell your doctor about us!
Ben Thompson, who in a past life was a Univeristy of Cambridge researcher, is an associate osteopath at Core Clapton.