Lower back pain: advances, yes but problem solved, no

As I sit gazing at the snowflakes fluttering down onto the contours of the Swiss Alps, my mild lower backache, as a consequence of a week’s hard skiing, reminds me of the severe lower back pain from which I suffered through my latter years of medical school and as a young doctor in the late 1970s. It was a very depressing but enlightening experience, which allowed me to discover the diversity of opinion in managing lower back pain. This sparked my interest in the specialty that has remained my passion ever since.

Over the years, I have consulted innumerable practitioners including osteopaths, chiropractors, physiotherapists, my own medical and surgical colleagues, and even faith healers – who could, at least, do no physical harm! Forty years later and opinions remain conflicted, despite the huge developments in technology that are highlighted in my article (click here).

Does lower back pain contribute significantly to your work load? Do you find helping your patients difficult?

Comment (1) Add yours ↓
  1. Mike Kirby Professor

    Back pain is a real issue and injection therapy has proved useful for many of my patients.
    The type of injection (and the skill of the HCP!!!) matters as demonstrated by the following systematic review performed in 2013:
    A total of 3,641 patients from 43 studies were included in this systematic review and meta-analysis. Indirect comparisons suggested epidural nonsteroid were more likely than nonepidural injections to achieve positive outcomes (risk ratio, 2.17; 95% CI, 1.87-2.53) and provide greater pain score reduction (mean difference, -0.15; 95% CI, -0.55 to 0.25). In the very limited direct comparisons, no significant differences were noted between epidural nonsteroid and nonepidural injections for either outcome (risk ratio [95% CI], 1.05 [0.88-1.25]; mean difference [95% CI], 0.22 [-0.50 to 0.94]).

    April 9, 2018 Reply

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