World Spine Day: The Importance of Self-help for Back Pain

Tuesday, October 16th marked the annual World Spine Day. Organised by the World Federation of Chiropractic, World Spine Day highlights the global burden of spinal pain and disability. This year’s theme, Love Your Spine, emphasised the importance of self-help in the management of back pain.

Low back pain is the biggest single global cause of years lived with disability. At any time, it is estimated that over 1 billion people around the world are suffering with low back pain, with 4 out of 5 adults experiencing at least one disabling episode during their lives. It can profoundly affect work life, home life and social life, and low back pain can lead to other health issues.  People suffering with persistent back pain are three times as likely to suffer mental health issues such as depression.

This year’s World Spine Day focused on how people can look after their spine and help prevent episodes of back pain. Under 1% of all back pain is caused by serious underlying problems, such as cancer and infection, yet people are often fearful of exercise and daily activities because they think it will make their condition worse. This is a myth, says World Spine Day Global Coordinator, Dr Robyn Brown, a medical doctor, currently working in the trauma and orthopaedics department at Gloucestershire Royal Hospital.

“The old-fashioned advice to rest or lie on a board has never been supported by evidence. To the contrary, prolonged rest can often lead to muscle wasting and stiffness and make the problem worse. People with back pain need to know that in the vast majority of cases, getting out, moving and continuing to live a normal life is the best treatment.”

Evidence has shown that low back pain can affect people across the life course, from schoolchildren to the elderly. A long term study in Denmark involving 1400 schoolchildren showed that over a 3 year period 55% of schoolchildren aged 5-15 suffered at least one episode of spinal pain. Although this was usually short-lived and trivial, one in five children was found to be suffering with three or more episodes per year and 17% of episodes lasted more than 4 weeks. Worryingly, child back pain sufferers are more likely to become adult back pain sufferers.

World Spine Day reaches around the globe and has attracted over 500 partner organizations globally, from hospitals and clinics to schools to government agencies, all committed to raising awareness and educating the public. On World Spine Day, activities took place around the globe to engage people around the #LoveYourSpine theme.

Earlier this year, The Lancet published a series of papers on low back pain. The papers were picked up by media around the world, and resulted in an explosion of social media attention, with over 15 million tweets alone. The findings of the authors were stark –  disability due to low back pain has increased by over 50% since 1990, especially in low and middle-income countries – yet access to effective services remains poor and many myths and misconceptions remain.

Dr Brown adds: “We know that back pain is complex and that it’s not just made worse by physical factors. Attitudes and anxiety around back pain as well as social factors also play a part. We call this the biopsychosocial model of back pain. One of the biggest challenges we face is that other than in a small proportion of cases it’s not possible to identify exactly what’s causing the pain.”

So who is most vulnerable to back pain?

“We do know that certain groups are more likely to report low back pain than others,” continues Dr Brown. “People with physically demanding jobs, people who have other physical and mental health issues, smokers and obese people are at the greatest risk of reporting low back pain.”

How do we prevent back pain and best advise people how to #LoveYourSpine?

The latest and best evidence does not support the use of drugs and surgery. The Lancet papers recommend education and self management strategies. Advice to get back to normal activities as quickly as possible and to exercise was seen to be most effective with psychological programs added to those with persistent symptoms.

The guidelines recommend limited use of medication, surgery and imaging, such as x-ray and MRI. In particular, inappropriate use of opioids and spinal injections for back pain came in for strong criticism.

Dr Brown says: “The most effective strategies are those that get people back to work early and educate them about the reality of back pain, that movement is medicine and that effective collaborations between patients and their health care teams of spine care professionals work best. See someone who will help you to help yourself ”

James B.