Back to Backs Trent Occupational Medicine Symposium. Philip Sell UHL and NUH 6 th October 2011. www.spinesurgeons.ac.uk. Population based intervention to change back pain beliefs and disability:three part evaluation. Rachelle Buchbinder et al BMJ no 7301 23 June 2001.
UHL and NUH
6th October 2011
Rachelle Buchbinder et al
BMJ no 7301 23 June 2001
Adams et al 2006
Symptom not a disease
cause unexplained in 85%
data are self-reported - questionnaires:
tell us about how people experience LBP
different questions give different numbers
Consequences more of a problem than symptoms
Low back pain is a common complaint among adolescents.
similar pattern to adults
Twins studies, controlling for environmental (occupational) factors:
70% of disc degeneration associated with genetic factors
Heritability of back pain possibly >50%
Muscle strength and level of fitness have little influence
Societal burden equal to depression, heart diseases or diabetes
Production loss (due to absenteeism and disability) far greatest impact
Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain. Pain 2002 95: 49-63. EM Haland Haldorsen et al.
Carter & Birrell 2000: www.facoccmed.ac.uk
Age >= 50 77 71
Previous cancer 31 98
Unexplained weight loss 15 94
Failure to improve 1/12 31 90
No relief in bed >90 46
Tackling Musculoskeletal Problems Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain.
a guide for clinic and workplace
identifying obstacles using the psychosocial flags framework
Kendall, Burton, Main, & Watson: TSO Books, 2009 www.tsoshop.co.uk/flags
Questions to ask
When you are in pain do you think it is terrible and will never get better?
Does pain feel overwhelming to you?
Chronic Low Back Pain
A Heterogeneous Condition With Challenges for an Evidence-Based Approach