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.
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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
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