Notes from Skepticamp, 9/14/13: A Skeptical Look at Back Pain

Posted on: Thu, 09/12/2013 - 3:01pm By: Alice

These are notes from a presentation given at the Skeptical Society of St. Louis Skepticamp on Saturday, September 14, 2013. Links to some of the resources and studies mentioned during the presentation, as well as additional links that may be of interest, are provided for those who would like to look at them.

 

A Skeptical Look at Back Pain: Notes from Skepticamp 2013

In 1995 I was working at St. Mary’s hospital when I heard about this study which examined 98 people who had no low back pain (LBP) and found that a large percentage had herniated discs. ("asymptomatic" means without symptoms i.e. no pain)

 http://www.nejm.org/doi/full/10.1056/NEJM199407143310201

            98 asymptomatic individuals ages 20 – 80

            36% normal discs at all levels

            52% bulging disc at at least 1 level

            38% abnormal at more than one level

            Findings similar in men & women

            Abnormalities increased with age

            Images – 21 yr. old man & 24 yr. old woman

 

I thought this would rock the world of pain management. It didn’t.

 

An earlier study in 1989 study looked at 67 asymptomatic individuals.

            31% had disc abnormalities or abnormal spinal canal

            7 year follow-up – 50 responded, 31 had repeat MRIs

            MRI not predictive of low back pain

http://www.ncbi.nlm.nih.gov/pubmed/11568190

 

More recently: March 14, 2013 New England Journal of Medicine
http://www.nejm.org/doi/full/10.1056/NEJMoa1209250

Patients at a pain clinic were examined before treatment and after one year. There was no correlation between the presence of herniated discs and pain. 

 

There is no change in the trend of rising cost of treating LBP in Western countries

Early MRI may actually lead to worse outcomes:

http://www.bodyinmind.org/spinal-mri-and-back-pain/

            

One reason may be belief reinforcement

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663473/?report=classic

            

Pain education is not a magic bullet but can reduce pain and even prevent pain. 

Learning Pain Science can Relieve and Prevent Pain

 

What can you do?

Educate yourself about pain. Lorimer Moseley is a pain science missionary. He is very funny and he is brilliant. Watch his videos!

15 Minute TED Talk on Why Pain Hurts.

25 Minute talk on how pain works

45 Minute talk to professionals about the biology of pain

Article on “the popping spine” with link to brief video, plus a video on pain on that page.

 

The book Explain Pain by Butler and Moseley is a must-read for anyone with pain or anyone who works with people in pain. If you don’t want to buy it, your library can get it on the interlibrary loan system. Better yet, request that your library get it in their system.

Use graded exposure to cultivate successful movement. Motion is lotion!

Gentle manual therapy can help your body to relax and turn down the volume on pain. 

 

Don’t panic! Most back pain is self-limiting.

 

 

Recommended reading for people who like geeky academic papers and studies on pain.

Pain and the Neuromatrix in the Brain by Melzack

The fall of the postural/structural/biomechanical model in manual and physical therapies by Lederman

Very detailed paper titled, simply, “Pain,” by Melzack and Katz. Not easy reading but describes the history and evolution of recent pain science – where we’ve been, where we are now.

http://onlinelibrary.wiley.com/doi/10.1002/wcs.1201/full

 

Thanks to the St. Louis Skeptical Society for allowing me to speak at Skepticamp!