Over 500 million people suffer from debilitating back pain globally. In the United States alone, a shocking 39% of adults say they experience this crippling affliction. That easy-to-hide, almost unavoidable joint pain has quickly become one of the most prevalent health issues facing Americans today. Consequently, scientists are investigating its underlying causes and alternative treatment modalities. A new study shows that identifying the source of back pain is key to informing the best approach to treatment.
The results highlight that millions of Americans who are in pain fail to find meaningful relief. Alarmingly, fewer than one in ten treatments had more benefits than a placebo. This shocking discovery is further indication that both patients and healthcare providers have to change the way we think about and treat back pain.
Understanding the Complexity of Back Pain
Back pain is not a cookie cutter condition, it’s usually complicated and multi-dimensional. Aidan Cashin, PhD, BExPhys, a senior research fellow and physiotherapist explains that while low back pain is common, it is very complex. First, because so many factors can affect and perpetuate a person’s experience of back pain, treating it can often be a complicated endeavor. This complexity requires careful consideration of each patient’s individual situation.
Healthcare providers widely agree that the first step in establishing treatment is knowing the exact type of back pain. Dr. Erica Urquhart, MD, PhD, challenged all of us to really identify the clinical problem in orthopedics. She thinks that understanding the patient’s story is key to building a successful treatment plan. Ignoring these complexities can result in harmful interventions that only mask the root causes of pain rather than treating them.
Recent studies indicate that psychological aspects play an even larger role in creating chronic back pain. Dr. David D. Clarke has made the point that pain of this origin is just as intense and debilitating as pain with structural origin. He insisted that it certainly isn’t made up. Rather, this insight emphasizes the importance of a more holistic approach to diagnosis and treatment.
Treatment Options and Their Efficacy
Their research categorized various types of treatments as well. It used clinical measures for efficacy based on how long the subjects had suffered from low back pain. The researchers were able to point to a number of extremely effective treatments for chronic pain patients. These are exercise, spinal manipulative therapy, taping, antidepressants and TRPV1 agonists. Acute low back pain tended to be treated with exercise, glucocorticoid injections, and acetaminophen.
Even with a wide array of treatment options available, patients often leave disappointed with the lack of results. Carmen Ospedale, MD, PhD, explained that her research showed how doctors inappropriately prescribed antibiotics and anesthetics for chronic low back pain. Sadly, these therapies were largely unsuccessful. The harsh truth is that just 10 percent of the treatments produced effects better than a placebo.
“Once we identified the relevant studies, we grouped them by treatment and by duration of low back pain experienced by the participants,” – Aidan Cashin, PhD, BExPhys
This methodical process was designed to shed some much-needed light on which treatments actually work to help patients relieve their pain. The absence of meaningful relief is still creating headaches for patients and providers alike.
The Path Forward: Psychological Considerations
Researchers are looking for new treatment paths. Now more than ever before, they’re becoming aware that psychological factors are central to how we approach and treat chronic pain. A 2021 study published in JAMA Psychiatry found that 66% of patients with non-specific chronic back pain experienced significant improvement after one year. Making room for psychological therapies would be a potent part of that overall strategy. This may be especially true for people who have not responded to traditional treatments.
Pain reprocessing therapy has recently been shown to be an effective psychological intervention for non-specific chronic back pain. This new therapy works by directly changing the brain’s perception of pain. It allows people to separate from their pain and reclaim much of their lost life.
Dr. Urquhart spoke about the need for comprehensive assessment in the treatment of low back pain. She noted, “As an orthopedic surgeon, I almost never walk away from a patient with an exact diagnosis with no diagnosis—low back pain. Such diligence in diagnosis can inform better treatment strategies tailored to individual patient needs.
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