Back Pain Research Review
Conclusions
While reviewing these conclusions it is important to keep in mind the
limited nature of the science behind the conclusions. A Level A Strong
evidence rating means that the findings concur in several, randomized
controlled trials of high quality.
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The other confidence levels are much less indicative of clearly
actionable findings.
Level B Moderate evidence – findings concur in one randomized
controlled trial of high quality or one or more randomized controlled
trials of low quality, or findings concur in several studies of low
quality.
One study regardless of quality in the study of a multivariate,
objectively indeterminate condition compounded by psycho-sociological
influences is inadequate to draw significant conclusions from other than
viable avenues for additional study.
Level C Limited evidence – based on one randomized controlled
trial (of high quality or low quality) or contradictory findings in
several studies. This level is a clear indication of a need for further
high quality studies.
Level D No evidence – no randomized controlled trials or other
types of studies of satisfactory scientific quality.
In primary care, the consultation itself offers a major opportunity
to influence both the acute and the more long-term course of
back problems. An essential aspect of the consultation is the
involvement of the caregiver and the ability to work with and
listen to the patient’s perceptions on back pain, mainly how it
impacts on daily life. The opportunity for the physician and the
patient to arrive at a common understanding about the nature
and course of back pain is of major importance for the prognosis
and is highly dependent on a good patient-doctor relationship.
Pain in the low back and neck is common. Low back pain
affects up to 80% of all people at some time during life, and neck
pain affects up to 50% of the population. In the overwhelming
majority of people, back pain does not signal a serious disease or
suggest that one should avoid normal daily activities. On the
contrary, scientific studies show that healing is promoted by
staying active, returning to work, and exercising at an appropriate
and increasing intensity.
- A thorough medical history and physical examination is important
for relieving anxiety about the consequences of pain and sufficient
for identifying the patients who should be referred to another
specialist for examination and treatment (eg, due to severe infection,
specific rheumatic disease, suspected cancer, or other serious
conditions).
- For most people with back pain, the interventions which can be
offered in primary care are the only ones needed. The physician’s
attitude
and ability to listen to and express empathy with the patient is
important for achieving a common understanding with the patient
concerning which treatment strategies would be effective.
This also has importance for the future course of back pain and
compliance with treatment advice.
- Back pain and its consequences are not isolated physical
problems but are associated with other conditions such as social,
psychological, and workplace-related factors. These factors,
stress, worry, and anxiety – along with the patient’s own perceptions
of and perceived ability to manage the problem – can be a determinative
factor in if the pain transitions from acute to more chronic pain. The obvious
role of psychosocial factors in this respect suggests that such factors
should be considered an integral part of back pain in relation to
conclusions
preventive efforts, in the initial phase of treatment, and later
during rehabilitation.
- Knowledge on how to prevent back pain has been applied and assessed to a surprisingly small degree.
The knowledge currently available should be applied and thoroughly
assessed.
- The relatively large resources that have been invested locally,
regionally, and nationally to prevent and rehabilitate back problems,
including interventions to improve the work environment, should be
subject to systematic assessment based on current knowledge about the
effects of various interventions. The sporadic research on prevention
and rehabilitation of back problems should also be assessed in terms
of its relevance and scientific quality
- .Many treatment methods are currently used, but there is little
scientific evidence on their benefits. Some treatment methods are
used despite scientific evidence showing that they do not benefit
the patient. The appropriateness of subsidizing ineffective treatments
with public funds should be investigated.
- The primary focus concerning back pain should be on the pain
itself and on the human suffering it involves. Furthermore, back
pain has an extensive economic impact on the individual and
society. The direct healthcare costs and the costs resulting from
sick leave and early retirement due to back pain reach an annual
sum that is over three times higher than the corresponding costs for
all cancer diseases.
Against this background, it is remarkable that
research on back pain, particularly research related to prevention,
pain relief, and rehabilitation is relatively limited in scope. Agencies
which have responsibility for and interest in effectively managing
back problems should take initiatives to stimulate and focus
research in this field, and disseminate information that is currently
available..
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