Back pain The signs are unmistakeable. If you see your neighbour with his or her hand pressed against their lower back, and holding themselves rigid, the diagnosis is clear – that gardening session has put their back out again. Every year up to 49% of the UK’s adult population has lower back pain – and if you’re in that 49%, you’ll know that even minor back pain can disrupt your life, stop you working and make you very uncomfortable. New research carried out at Warwick Medical School, at the University of Warwick, has shown that there are ways to reduce the amount of lower back-pain that we feel, without resorting to drugs or operations.
Professor Sarah E Lamb and her team at the Warwick Clinical Trials Unit, carried out a randomised controlled trial of 701 patients from GP practices in England, who had subacute or chronic low-back pain. The results are published in an article in The Lancet this week. The patients were randomly allocated to two groups. 468 people received a single session of advice on back pain, followed by one and a half hours of group cognitive behavioural intervention for six weeks. The 233 people in the control group received just the single session of advice. The study found that one year after the trial the group that had received the cognitive behavioural treatment had improved significantly.
"Those people in the cognitive behavioural group had a one to one assessment with a trained therapist to start with," explains Zara Hansen, a clinical researcher who was involved in the trial. "The group cognitive behavioural intervention covered different skills each week, such as understanding pain, identifying and tackling unhelpful beliefs, relaxation and setting goals for activity levels without causing flare-ups," she said.
"One of the aims was to give the participants the ability to understand the vicious cycles that we can experience with back pain. For instance, if we feel that we are doing something that will hurt us, the natural instinct is to stop, become less mobile, and do less. The result is that we become less fit and de-conditioned, which creates more problems.
"Or, we may do a lot when we’re feeling good, have a flare-up of back pain, which sets us back, then when we start to feel better again, over-do it again," says Zara Hansen. "We call it the boom-bust cycle, with cycles of under-activity and then over-activity. The things that we naturally do when we’re trying to avoid pain are often our worst enemy. We can stop moving, become stiff, weak and fearful, stop doing enjoyable activities and feel low. By helping people to understand pain, our aim was to help them manage it themselves."
"I’m not surprised that they had really good results," says Sash Newman, Chief Executive of the charity BackCare. "We always advocate that you should keep moving as much as possible. Managing back pain is all about listening to your own body, knowing your own limitations and working out what you can and can’t do. If you can only walk two steps, try for three. If you can’t manage it today, try again tomorrow."
About 30 million people a year suffer from back pain. It’s the biggest cause of days taken off sick, and resulted in almost five million lost working days in 2003-4. Although back pain isn’t always severe, because so many of us suffer from it, this condition is expensive. The NHS spends over £1 billion a year on costs relating to back pain. As well as having positive results, the Warwick team believe that their treatment trial has another important benefit, it’s cost-effective, and, allowing for adjustments, works out about half the cost of competing treatments.
First published February 26, 2010