Back pain. Why we can’t fix it

Unsure doctor

Low back pain is one of the failings of modern medicine. Despite our best efforts, it is “estimated around 3.7 million Australians (16% of the population) have back problems and 70–90% of people will suffer from lower back pain in some form at some point in their lives”(1). We can attribute this pain to a disease process or structural cause for 8-15% of sufferers, however that leaves a significant portion of the population suffering from what’s known as ‘Non-specific low back pain’. Unfortunately for this demographic of patients, their pain often becomes chronic and hasn’t yielded to any modern treatment methods with any regularity.

Despite our advancements in detailed scans, other diagnostics and modern treatment methods, back pain is becoming more prevalent and it’s solution still eludes us. Why is this? Has it developed chronologically? Was it treated differently or is our modern lifestyle responsible for it’s rise?

Historically we have little information from medical writers about back pain. Unsurprisingly, it appears that a sore back would be somewhat overlooked compared to fatal illnesses of the time. Whilst we can identify evidence of degenerative processes in the earliest human remains, modern literature has shown repeatedly that there is no link between these changes and pain. Given the rise in back pain, can we draw any insight as to its development or how our predecessors might have treated and managed it?

Earliest writings of back pain occurred in 400BC where it was a commonly associated symptom of many illnesses and was hence treated symptomatically. Common treatments of the time included spas or soothing local applications, whilst the legs of sciatic patients were smoked in a fire of ferns.

By the 1800’s physicians began to look for the cause of back pain. It was thought to be a form of rheumatism caused by the cold or damp. Rheumatic phlegm was believed to build up in the muscles and consequently treatment involved every attempt at removing the congestion. The increase in understanding of disease in the later parts of the century, showed several causes of back pain related to more significant disease processes of the large blood vessels in the abdomen or gastrointestinal tract.

In the 19th Century the idea that irritation to the spine could be the cause of pain, laid the foundation for modern treatment of back pain. Repetitive activities sparked by the industrial revolution seemed a plausible causative factor for the dramatic increases in back pain aptly know as ‘railway spine’.

Fundamentally, our modern understanding of back pain hasn’t advanced much further beyond ‘irritation of the spine caused from repetitive activities’. Except now the repetitive activity we are doing isn’t lifting railway sleepers, it’s sitting in chairs.

Evolution

What has changed however, is the way we treat pain. Historically pain has been treated as one aspect of human illness. With advancements in medicine it appears that the role of the physician has changed and patients want instant relief for their symptoms, a quick fix. Pain medications do well to mask the symptoms, although they do not address the cause. We have also created an environment in which it’s inhabitants are more stressed, tired and anxious than ever before and it’s no surprise these heightened levels have also been implicated in back pain. Combine this with a population limited in movement variability and unrealistic healing expectations and it’s easy to see why the back pain puzzle has yet to be solved.

Each patient’s back pain, movement, lifestyle and belief system is unique to that individual; and until we begin to address it as such, this writer fears it’s commonality will continue to rise.

 

References

  1. Background Paper 6.24 Low back pain
  2. Australian institute of health and welfare
  3. institute of health and welfare
  4. It’s time for a change with the management of chronic non-specific low back pain
  5. Epidemiology of low back pain in primary care
  6. A historical perspective on low back pain and disability
  7. Why Australians are more stressed then ever

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