Non-specific low back pain is back pain that is not attributed to a known cause and accounts for approximately 90-95% of all cases of low back pain. Low back pain is a major cause of disability in Australia, with a quarter of all Australians experiencing low back pain at any one time. This blog will discuss important factors to consider in the diagnosis of non-specific low back pain and simple management strategies you can use to manage your pain.
Diagnosis
- Don’t rush to get a scan or see a specialist – guidelines from around the world unanimously recommend against the use of routine scans, such as xrays and MRIs in the diagnosis of low back pain. These scans are not indicated as they will often identify asymptomatic findings that are not relevant to your pain and can increase the use of unrequired invasive treatments such as surgery. Referral for a scan is only indicated in the case of suspicion of a specific pathology. Australian guidelines state that in the absence of suspicion of a specific pathology, referral to a medical specialist should only occur if the patient has not recovered by twelve weeks.
- Understand the psychosocial factors – non-specific low back pain is a lot more complex than you may think and many things can affect your pain. Factors such as stressors at home or work, lack of sleep, fear avoidance behaviours and negative attitudes and beliefs towards your condition can all affect your pain. Identifying relevant psychosocial flags allow physiotherapists to identify aspects of the person, their problem, and their social context, and how those factors affect their prognosis and recovery.
Treatment
- Movement is good! Avoid sedentary behaviours such as bed rest and prolonged sitting as this will often make symptoms worse.
- Try to maintain a normal daily routine as close as possible. Your back will recognise that these movements are safe and should become more comfortable to perform with time.
- Pain medication – simple analgesics such as paracetamol or non-steroid anti-inflammatories used on a short term basis may provide some pain relief. It is important to consider possible adverse reactions. Opiates are not recommended and should be avoided.
- Seek professional help – visit your Physiotherapist so they can assess your individual case. Your physiotherapist will tailor a treatment plan specifically to you and can educate and guide you on the next steps in your recovery.
References:
Oliveira, C.B., Maher, C.G., Pinto, R.Z. et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 27, 2791–2803 (2018). https://doi.org/10.1007/s00586-018-5673-2
