The non-specific back pain myth; the hidden reason behind chronic back problems.
The Annals of Internal Medicine in February 2017 showed a strong link between movement and back pain. The opioid crisis was partially created because medical physicians believed that medication for back pain was a satisfactory treatment for the condition. This idea was years in the making when the American Medical Association decided that pain control was a priority when treating patients for problems such as back pain. The profession of pain management developed out of this idea.
Chronic back pain begins for most of us with an episode that may have self resolved. Medically, this has been referred to as non specific back pain since the pain went away on its own. The idea also suggests there is no identifiable cause for the pain. The term non-specific back pain has been published in numerous journal articles and has rarely been questioned. Non-specific back pain often develops into chronic back problems as we age. Perhaps this dogmatic belief is a result of most medical providers having only three credit hours of training in the musculoskeletal system. The other part of the belief has to do with the symptom based approach to care and evaluation of many chronic conditions that often results in a drug, tests or an invasive approach to care such as surgery or an injection.
The chiropractic profession has grown since they look at motion and mobility and understand the importance of a holistic approach to evaluation and that treatment. Many patients in the medical model for pain related conditions do not improve or worse, become dependent on medication because of the ineffectiveness of the approach to care. Chiropractors understand that to resolve back, neck, shoulder knee and most joint pain, treatment must include the restoration of movement in joints of the spine, extremities and fascial systems.
Resolving a back problem requires a great evaluation and a thorough history.
Evaluating a patients lower back may include static orthopedic tests and even an MRI. Rarely does this evaluation include active tests which help providers better understand the mechanical and neurological dysfunctions causing the pain. Medically speaking, when a test or standard examination methods fail to help doctors understand the problem, they will use terms like non specific or idiopathic which is medical jargon for the cause of the problem being unidentified.
Most healthcare providers are taught to ask you where you hurt and about any other symptoms you believe are significant. Patients rarely tell their doctors about problems they have had in the past unless they were asked, and valuable clues to understanding them better are often found by knowing about these past symptoms. Unless your doctor knows what to ask, they will do a lower back work-up for a lower back complaint without ever knowing to ask about your foot pain, plantar fasciitis and neck problems.
If all of our tests during our exam and our MRI are negative, we often refer to the condition as non specific back pain. Insurance companies have used the term non specific back pain to limit care, which is a huge problem in workers compensation. Unless health care providers can properly understand why their patients hurt, the patient is more likely to have future episodes of back, neck, shoulder and even knee problems. They may also have expensive injections or procedures for a finding on an MRI, but long term may show the treatment to be of little value because these methods are not movement based which the medical literature shows to be effective for back and even neck pain. This is why a generalist approach to primary care for musculoskeletal conditions is more appropriate than a specialist based approach commonly seen in medicine today.
The problem with back and other medical specialists
This type of thinking behind back pain which looks at the patients complaint, but ignores the mechanism causing the complaint has resulted in many chronic back pain sufferers being given medication for their mechanical problem. Years later, the mechanism behind their non specific back pain may have caused problem in the knees, hips, shoulders and of course, their back. For those who have had non specific back pain, it is likely you have had other problems treated by other specialists who make up a hodgepodge of disassociated approaches to different parts of the body that hurts. It is also common that these chronic stresses on the body now are showing up on an x ray as arthritis to the joints of the spine and extremities.
The body is a holistic interconnected mechanism which requires coordinated movement and symmetry. Movement should be like a slinky and the nuances of movement are affected by the fascia, the joints, the nerves and the muscles. A poorly functioning system will cause many common problems in the back, neck, shoulder and even wrist and elbow.
To resolve back problems, your health care provider must understand movement.
Movement based professions such as chiropractic have had great success with these patients since they approach the body from a more holistic point of view. As the Annals of Internal Medicine has shown us, back problems are a movement issue. While they did not come out and say this directly, they did suggest that drugs and invasive interventions should be considered last, while methods that improve movement such as manipulation, exercise and myofascial release should be a first approach for patient who are in pain. Ironically, the idea of non- specific back pain that just goes away has many sufferers mistakenly believing back pain is the condition, when movement is. This believe has resulted in many people becoming chronic back pain sufferers who may out of desperation years later have surgery to their back or have a joint replaced because the medical provider they saw years before did not fully understand why their patient was in pain.
Is the term non specific back pain was deceptive form of marketing? It would seem, as it did in 1994 when the AHCPR published their articles in back pain that motion based care such as chiropractic should be the first choice for back pain. On the other hand, many medical providers have subjected these patients to unproven and sometimes harmful treatments and surgeries instead of recommending them to a chiropractor. When the AHCPR came out with their studies on back pain, the American College of Surgeons came out with their own protocols that were drug and surgery based, while ignoring the science behind movement and back pain. They also lobbied to defund the agency making it difficult for them to successfully publish many future studies. This was intellectually dishonest.
Whom you see first will determine your experience with resolving your back pain and many other related conditions.
Medically, most healthcare providers are poorly trained to evaluate and properly treat many of the chronic painful ailments in the human body such as plantar fasciitis, knee pain, back pain, neck pain and even shoulder pain. These are all conditions related to movement and the way we function, something not seen from a medical specialists non holistic point of view. For the foot, you will see a podiatrist; for your knee, maybe an orthopedist; for pain, a pain management provider and so on. This approach has been sold to the public as being superior because they specialize in an area, when in reality, it is like making soup with several people and hoping it tastes ok. This approach alone has driven costs skyward, increasing the usage of medications for pain, while increasing the usage of injections, surgeries and other interventions. When conservative care is needed, most of these patients are sent for physical therapy where exercises are done to the symptomatic area with the dogmatic belief that this will resolve the condition as well.
On the other hand, you can see a primary doctor for the musculoskeletal system who has been trained in evaluating movement, and why we hurt. This provider is a chiropractor; A holistic provider who will take a thorough history, and treat the muscles, fascia, improve nerve function and give you rehabilitative exercises, usually in one place and at a much lower cost. They will order fewer medical tests because they rarely are a replacement for a thorough musculoskeletal evaluation. They will refer you if something more serious is suspected to a medical provider and they will order appropriate tests if you fail with a reasonable course of treatment for your lower back pain and also be thorough enough to prevent future problems from developing. They will not call your back pain non-specific, but will look at how you move and understand why you hurt.
Whom should you visit first for back pain and other joint related pain? All roads lead to the chiropractor.