Managing long-term back pain: a comprehensive approach

Back pain is a pervasive health concern worldwide, ranking at the top of the Global Burden of Disease list. Nearly every adult experiences back pain at some point in their life. Previously, it was believed that back pain primarily afflicted those in developed countries and was often linked to prolonged periods of sitting. However, recent studies reveal that back pain is on the rise across developed, middle-income, and underdeveloped nations alike.

In Bangladesh, for instance, around 60% of adults suffer from back pain. This pain can manifest in three forms: short-term, medium-term, and long-term, with the latter presenting the most complex challenges as it persists for three months or even years.

What causes chronic pain?

Long-term back pain remains an enigma, baffling scientists and medical practitioners globally. While common perceptions suggest that disc prolapse, PLID, bone loss, or spondylosis are the culprits, MRI and X-ray reports often contradict these assumptions.

In most cases of long-term low back pain, these imaging studies reveal no significant bone or disc issues, and physical examinations do not uncover major muscle tension or other visible problems. This pain, shrouded in mystery, has been termed non-specific chronic low back pain, abbreviated as NSCLBP.

How is the disease diagnosed?

NSCLBP proves to be a complex issue, with its roots in multifaceted factors that range from psychological and socioeconomic conditions to minor bone loss or low PLID levels. To diagnose these problems, understanding the patient's medical history and lifestyle is essential, along with various pathological and radiological tests. In addressing this issue, cooperation between the doctor and patient is paramount, with the physician possessing a comprehensive understanding of back pain.

What treatments are available?

Many patients suffering from chronic back pain have resorted to various medications for extended periods without experiencing the desired relief. Research consistently suggests that medication has limited efficacy in addressing long-term back pain. Similarly, conventional physiotherapy methods such as shortwave, microwave, traction, or ultrasound treatments yield suboptimal results. To commence treatment, it is crucial to rule out any red or yellow flag signs indicating complex underlying issues, such as cancer. In the absence of such concerns, multidisciplinary treatment should be considered, tailored to the patient's specific needs, for more favourable outcomes.

Expert advice

Patients with chronic low back pain are advised against using orthotics or waist belts. Resting excessively is unnecessary; instead, remaining active, regular walking, and seizing opportunities for physical activity are encouraged. Engaging in social and religious activities can provide positive distractions and improve overall well-being. For Muslim patients without red or yellow flags, maintaining regular prayer routines is essential.

In conclusion, managing long-term back pain demands a holistic and patient-specific approach. Rather than relying solely on medication or traditional physiotherapy, a multidisciplinary strategy that considers the individual's unique circumstances can yield more promising results. By fostering cooperation between healthcare professionals and patients, we can better understand and alleviate the burden of chronic back pain.

The writer is a Back Pain Researcher at La Trobe University, Melbourne, Australia.

E-mail: hprc2005@live.com