“Is my back pain coming from my head?”
Jon Ford, Specialist Pain Physiotherapist
As the founder of Advance Healthcare, I have seen 100s of patients who reported having been told that their pain is “coming from their head”. When patients have this perception they often feel upset, invalidated and dismissed. So, what is the right information for people with low back pain and how should it be presented? The answer is complex… but read on!
Firstly, it is important to acknowledge that communicating complex information to people with low back, and particularly chronic (> 3 months) low back pain is challenging. Most university degrees for practitioners don’t provide adequate training on helping patients understand their pain. As a result, practitioners can struggle to provide a clear patient explanation on the nature of the pain problem. Secondly, people with low back pain are often understandably distressed and can even have memory or concentration difficulties. Understanding pain can be challenging for patients as well. And finally, as discussed below, every patient is different!
The recently published “Low back pain clinical care standard” offers sensible and research based information for people with pain. However, some of this information when applied in a “one size fits all” manner can be a problem. Based on our own research program as well as other available research evidence:
Many cases of recent onset and minor low back pain do get better with minimal treatment as recommended in the standards document. However, it is very common for more severe low back pain problems to become chronic or “recurrent”. For these people “simple and cost effective” treatment is not enough. Getting the right treatment early on is critical in ensuring you have a rapid recovery
It is true that in many cases radiological imaging (like MRI scans) can be misinterpreted by patients and practitioners. But for chronic low back pain, an MRI can be very useful in establishing the cause of the pain provided it is interpreted in combination with a detailed clinical assessment. MRI can also rule out significant injury to the low back and provide reassurance to a patient that it is safe to move. A careful explanation from the practitioner can help the patient understand the nature of their pain problem and the relevance of the MRI findings. Simply put, and contrary to the standards document; radiological imaging is necessary in many cases of chronic pain
The standards correctly suggest that “psychosocial factors” and “psychological assessment” can be relevant for some patients with chronic low back pain. However, it is common and completely normal for people with pain to feel distressed and experience low mood. Sometimes psychology treatment (in combination with physiotherapy) is very helpful. But in other cases, when the physical cause of the chronic pain is identified and successfully treated these “psychosocial factors” resolve of their own accord and psychological treatment is not needed.
Physical activity, as recommended in the standards, is usually a sensible approach for low back pain. However, in chronic or severe low back pain it can be very challenging to work out which physical activities are helpful or not. Simply pushing into the pain by doing more and more physical activity is often not the answer and can sometimes worsen the pain problem.
Put simply (and as described here) people with low back pain can be thought of as having:
Pain coming primarily from a physical injury (including nerve injuries) that requires a quality physiotherapy program to identify the problem and provide the right physical treatment
Pain coming from a complex combination of physical, nervous system and psychologically related factors. Understanding and treating this problem effectively often needs a “multi-disciplinary” combination of medical, physiotherapy and psychology based treatment. Check out our video here on this type of pain problem
One size does not fit all! The practitioners at Advance Healthcare can assess the nature of your pain problem and provide advice on the best type of individualised treatment to support your recovery. Contact info@advancehealthcare.com.au for more information.
In the early 90s whilst lecturing at The University of Melbourne Jon began developing evidence-based treatment models for people with back pain. He subsequently established Spinal Management Clinics (part of the LifeCare group) which became one of the leading providers of physiotherapy and multi-disciplinary pain management programs in Australia.