5 Takeaways from the Economist – on Chronic Back Pain

In this video, Leon discusses the 5 key takeaways from the Economist briefing on chronic back pain. Many of these points are aligned with the evidence we post regularly on this website.

Takeaway #1 – X-rays and other imaging procedures are not good predictors of pain.

• About 50% of the population undergoing MRI scans find some degree of spinal abnormality on imaging.
  • These abnormalities may include bulging discs, herniated discs, spinal wear and tear, etc.
  • These findings don’t always correlate with the pain a patient is experiencing – some patients have significant spinal issues but experience no symptoms.
• Results of imaging don’t always help determine the underlying cause of back pain.
  • Sometimes imaging will find a spinal issue but that doesn’t always mean that issue is the source of pain.
  • Further diagnostic workup is often needed to determine the cause of back pain.
• Disc degeneration is seen on imaging in about ½ of young to middle-aged adults with back pain, and in about 1/3 of patients with no back pain at all.
• Disc protrusion is seen on imaging in about 40% of patients with back pain, but also in approximately 20% of those who are pain-free.
• There is a broad consensus from the University of Southern Denmark that about 80% of such scans are useless.

Takeaway #2 – Prescription medications (like opioids) don’t necessarily help with back pain.

• Many doctors continue to prescribe medications for pain control, including opioids.
• Research is finding that these medications don’t necessarily help control back pain, but have other side effects, including:
  • Making you feel loopy.
  • Decreasing quality of life.
• These medications may also lead to addiction.

Takeaway #3 – Back surgery doesn’t actually help many back pain patients.

• Many patients have surgery but continue to experience significant pain several years later.
  • For example – spinal fusion surgery is often used for degeneration of spinal discs. In 2015 approximately 85,000 of these procedures were performed. However, 2 years after treatment 87% of patients still had severe back pain requiring medication, and 15% had additional surgery
• Surgery should be a last resort after exhausting all conservative treatment options.
• Surgeons do not always follow the evidence.
• Be informed before undergoing back surgery – get a second, and maybe even a third, opinion.

Takeaway #4 – New research is coming out surrounding pain science.

• Research is showing that chronic pain can be coming from your brain as the brain interrupts the pain you’re feeling.
• A lot of people don’t want to hear this, or are uninformed about the connection between mental health and chronic pain.
• Stress at work, or in personal relationships, etc. may be contributing to your chronic pain.
• There’s a lot more to chronic pain than just the physical cause or what you may see on an X-ray.

Takeaway #5 – Exercise and stress reduction is proving to be effective for back pain.

• Daily exercise, including stretching, can help to control chronic back pain.
• Reducing stress with activities like meditation, yoga, Thai chi, and acupuncture can help to control chronic back pain.
• It’s important to not focus all of your attention on your pain.

In closing, stay active, avoid medications and surgery whenever possible, and try to treat yourself holistically.

Related:
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