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Low back pain is a big deal: Findings from The Lancet series


The series

Last year, British medical journal The Lancet produced a series on low back pain which summarised international and multidisciplinary guidelines for the most up-to-date evidence based management of low back pain.

The series was steered by an international group of authors led by Melbourne’s own Rachelle Buchbinder, a rheumatologist and clinical epidemiologist, Director of the Monash Department of Clinical Epidemiology.

The findings

The series finds that low back pain is extremely common in all age groups and populations worldwide. Low back pain is now the leading cause of disability worldwide, having increased 54% between 1990-2015, with the biggest increase seen in low-income and middle-income countries. Disability from low back pain is highest in working age groups worldwide. Costs associated with health care and lost income are significant.

Low back pain is a complex condition with many contributors to the patient’s pain experience and disability. People with physically demanding jobs, people who already suffer with poor physical or mental health conditions, smokers and obese people are at greatest risk.

Only a small number of people have a well-understood pathological cause such as a vertebral fracture, malignancy or infection. Most people with new occurrence of low back pain recover quickly, though recurrence is common, and in a small proportion of people, low back pain becomes persistent and disabling. Increasing evidence shows that low back pain disability is affected by psychological factors, social factors, biophysical factors, comorbidities, and the individual’s pain processing mechanisms. Many imaging studies (MRI, CT and radiography) identify findings that are also common in people without such pain, and their importance in diagnosis is a source of debate particularly in populations over 50 years of age.

The recommendations

Some of the important guideline recommendations summarised by the series include:

· First-line of treatment largely involves non-pharmacological, conservative care including manual therapy, advice to stay active, patient education that supports self-management, and psychological therapy for those with persistent symptoms;

· Prudent use of pharmacological and surgical treatments with a total avoidance of prescribing opioids;

· Routine use of imaging and investigations is not recommended (unless clinically relevant and is considered less informative in populations over 50 years of age);

· The only effective interventions for secondary re-occurrence are exercise combined with education, however, little prevention research exists.

An osteopathic perspective

Osteopaths are primary practitioners and therefore equipped to offer you the first line of treatment, and to provide rehabilitation exercises to prevent reoccurrence, in accordance with these guideline summaries. We do this by the hands-on manual therapy, along with education on how to manage your pain and rehabilitation exercises. Care is taken to apply clinical reasoning to the individual, to ensure your low back pain is diagnosed and appropriate care is tailored to your needs.

For a comprehensive background and summary of the guidelines please review the references listed below.


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This post was written by Dr Jess Davies.

You can find out more about Jess here or book an appointment with her here.

Alternatively, you can call the clinic on 9908 2844.

Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Gebevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M. (2018). What low back pain is and why we need to pay attention. Lancet 391, 2356-67
Foster, N., Anema, J. R., Cherkin, D., Chou, R., ohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., Turner, J. A., Maher, C. G. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 391, 2368-83

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