Welcome to

My back pain journey is an interactive guide to help you make

sense of back pain. It provides you with a comprehensive

overview of current healthcare practices, with advice on what

to do in the short and long term.

It is supported by the latest evidence and has helpful

resources that you can access at the touch of a button.

Just click and go!

Click here after you’ve explored your journey

What is back pain?

• Back pain is commonly understood to be:

• A result of a structural problem in the spine (a disc bulge, ligament sprain)

• Something being out of alignment (a joint)

• Imbalances and/or asymmetries in the spine and or body leading to injury

• No evidence supports this theory

• In Fact:

• Most back pain is a result of simple strains or sprains

• Back pain is common like the flu, or fatigue or stress. It has a recurrence rate of around 40%

• A lack of sleep can have a profound effect on back pain

• How we feel can influence the amount of back pain we feel.

• Managing stress, mood and worry can help to reduce back pain. Click to return to main

screen

(Lederman, 2010; Maher, O’Keefe & O’Sullivan, 2016)

https://soundcloud.com/bmjpodcasts/effectiv

e-treatments-for-back-pain-kieran-

osullivans-practical-tips-within-a-guiding-

framework

Check out this podcast for tips on manging

back pain

What about the disc?

The intervertebral disc in your spine gets blamed

for a lot of pain

BUT:Discs are highly adaptable, they may have

healing abilities (Adams, Stefanakis, & Dolan,

2010). Check out these facts about your

amazing healing disc!

It is safe to adopt a wait and watch policy for

cases of massive disc injury if there is any sign

of early clinical improvement (Benson et

al.,2010).

Having a large disc injury is not necessarily

something to be concerned about. The immune

system mops it up (Chiu et al., 2015).

Massive disc injuries usually reduce in volume

and by 6 months most are only a third of their

original size.

Click to return to main screen

Scans are widely used as means of identifying

what could be the source of your pain:

BUT…

Studies have shown that use of early MRIs for

acute back pain have have poorer health

outcomes (Webster et al., 2013; Graves et al.,

2012).

Over 40% of people without any pain have bulging

discs on MRI (The chart opposite shows this)

35% of athletes have significant damage on MRI

scans but don’t experience any pain.

Lumbar spine degeneration starts in a person’s

early 20’s – there is little correlation between

arthritis & back pain (Leboeuf-Yde et al., 2005).

The strongest predictor for LBP was depression

not MRI findings

“Clinicians are not mechanics and we are not

dealing with motorcars.” Jørgen Jevne (2015).

PAIN IS WEIRD!

The people in this study reported no pain

Jarvik et al., 2005; Brinjikji et al (2014)

Click to return to main screen

• We know from extensive research that back pain is heavily influenced by the following:

• Attitude and beliefs• What we understand and think about our back

• Behaviour• How we act and move in response to our back

pain

• Compensation• Are we receiving financial support? Are we

concerned that we may not received support

• Diagnosis• Are we awaiting a diagnosis or searching for a

reason why we have back pain

• Emotions• Are we scared, anxious or fearful about our

back pain

• Family• What impact do our friends and family have on

how they view your back pain.

• Work• What impact does your back have on work or

whether you feel you can workClick to return to main

screen(Kendall & Watson, 2000; Louw & Puentedura, 2013)

Most back pain is a result of simple

sprains or strains (97%)

In RARE cases (1-2%) people report one

or a combination of the following:

• Loss of bowel or bladder function

• Numbness in the groin or back

passage

• Loss of sexual function

• Pins and needles into both legs

• Unsteadiness of walking

• Rapid weight loss

• Unremitting constant pain that does

not vary in a 24 hour period

• Previous history of cancer

(Downie et al., 2013;Greenhalgh & Selfe., 2006)

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• You may not think it but words can have an enduring impact on back pain.

• Did you know:• That what you believe about your

back pain, it is likely your clinician will too.

• That if you think an activity is bad for your back, your clinician may well think the same.

• That clinicians telling you what not to do over what you can do has an impact on your activty levels

• This can have a negative effect on your recovery and even increase a sense of vulnerability about your back.

• Take a look at the image opposite to get a sense of what people said about their backs.

Pain is an ideal habitat for worry to flourish

Click to return to main screen

(Darlow et al., 2013;

Eccleston & Crombez,

2007; Darlow et al., 2015)

• Commonly education focuses on tissue:

• Anatomical posters• Anatomical models• Booklets/Pamphlets

• Unfortunately these models use information that has been shown to fear

• These models also have a profound –veeffect on functional ability

• Pain education• Helped to pain

ratings • Helped to pain in

short and long term• Immediate increase

in spinal movement

• One to one & group• Significant decrease

in pain• Significant

improvement on function and disability

Click to return to main screen

Patients in pain want to know more about

about pain, not anatomy.

Louw, Deiner et

al., (2011)

Click on the green flag once finished

• Non Steroidal Anti-inflammatory medication is the most commonly prescribed medication

• Provides short term symptomatic relief of acute and chronic back pain without sciatica (Roelofs et al., 2008)

• Paracetamol• Is commonly prescribed but has been

shown to be ineffective for low back pain (Machado et al., 2015; Saragiottoet al., 2016).

• Sciatica (neuropathic pain)• Combination therapy = gabapentin +

opioid has been shown to provide pain relief (Chaparro et al., 2012)

• Amitriptyline or Nortriptyline may also be prescribed. These are strong medications to help turn the volume down.

• Side-effects• As with all medication there are side-

effects so best to speak to your G.P or Pharmacist for advice Return to what now

Check out this resource on opioidshttps://youtu.be/MI1m

yFQPdCE

• Conservative treatment can help• It can provide short term pain relief

• Some practitioners may use techniques such as manipulative therapy, acupuncture or taping, although helpful in the short term if your pain persists discontinue use.

• Health professionals should be:• Good listeners

• Acknowledge and be empathic to your concerns about your back pain

• Provide reassuring advice

• Always ask questions and don’t be afraid to ask for the clinicians knowledge of back pain research.

• Many treatments are ineffective in the long term

• Don’t be too hasty to ask for that scan or x-ray.

(Furlan et al., 2005 & 2015; Rubinstein et al., 2011 & 2012)

Return to what nowReturn to what now

• Epidural Steroid injection is a common method of treating low back pain

• There are very poor outcomes for providing effective relief for back pain

• They don’t reduce the rate of subsequent surgery

• They don’t appear to improve long term activity or function

• Nerve blocks have been shown to have poor outcomes in the long term.

• Injections into the facet joint have been shown to be no more effective than saline injection.

(Airaksinen et al., 2006; Armon et al., 2007; Staal et al.,

2008)

Return to what now

• Most common surgeries for back pain are:

• Discectomy – removal of the herniation

• Spinal Fusion – the fusion of two vertebrae and complete removal of the intervertebral disc

• There are very poor outcomes associated with above surgeries

• Discectomy and spinal fusion not helpful for back pain associated with disc herniation or Degenerative Disc Disease (without sciatica)

• Some effectiveness in reducing sciatic pain

• The results for spinal surgery are no better in the medium or long term

• Talking to a clinician that specializes in pain and staying active is as effective

(Mirza & Deyo., 2007; Deyo et al., 2009)

number of medical treatments = rates of disability

Return to what now

• Movement is important for maintaining Physical health (joint, muscle) and mental health

• ”healthy” individuals following exercise:

• Moderate to high intensity

• Pain inhibition

• Aerobic = 30 minutes

• Weight training = 5minutes

• Not the case in some persistent pain presentations

• Associated with ‘flare ups’

• Movement and loading of the spine at slow to moderate movement speeds = positive adaptations, tissue strengthens (Belavý et al., 2015).

• Walking for 10mins at 100-110HR elicits exercise analgesia (Hoffman, Shepanski et al.,2004)

Return to what now

(Sluka, O’Donnell, Danielson, & Rasmussen, 2013)

• Pain can be distressing, resulting in effects to our mood and behaviour

• Cognitive behavioural Therapy:• Discussing beliefs about your pain and

changing your behaviour• Showed small to moderate improvements

in disability, mood and catastrophic thinking.

• Acceptance and Commitment Therapy

• Focus on your values in the presence of pain

• Brings about behaviour change and improve functioning

• Large improvements shown in pain acceptance, psychological flexibility, anxiety and depression.

• Small improvements in pain intesitiy and physical functioning

• Graded Exposure• Based upon the movement/action or

context the person fears, then exposing to gradually to the fear without avoiding or withdrawing

Return to what now(Williams, Morley, & Eccleston, 2009;

Hughes et al., 2016; Thompson, 2015)

• A way to break free from our default

‘autopilot’ mode & wake up & observe.

• Cusens et al., (2010) 65% patients

report improved acceptance &

reduction of medications.

https://youtu.be/VYht-guymF4

Click the link for an ACT video

• Feeling good

• Start to become more active

Boom

• Household chores

• Do too much

Bust• Increase pain

• Decondition

• Become avoidant to activity

Boom

• Days/Weekslater

• Feel better

• Do too much

Bust

DECREASE IN

ACTIVTY

INCREASE IN

AVOIDANCE

BEHAVIOUR

The downward

spiral

Boom and

bust

• Two common types of coping mechanisms

• The downward spiral • Boom and bust• Essentially we do too much and

flare ups occur which can force us to do less and less

Good spell with low pain

Over push

activities

Increased pain

Forced under

activity

Return to what now

• Flare ups are common and although unpleasant are not cause for concern

• A flare up is when the pain that you feel is above what is “normal” to the individual

• They occur due to the nervous system being overly-sensitive and can be triggered by many factors

• Physical

• Environmental

• Stress

• Context

• It is important to know that you should expect to hit stormy conditions on your journey

Expect to hit stormy conditions

Return to what now

Setting Goals and Pacing

• It’s important to set goals that are related to your values

• What is important to you?

• What would you do tomorrow if you had no pain?

• Why is the thing that you enjoyed important to you?

• A value is for life not just an achievement

• Don’t push too hard or pain will push back

• Start-steady and build up slowly

• Remember the stormy sea

• Important to have a set back plan

• Use something to control the pain

• Recognise what’s happening. Don’t Panic!

• Modify your activities for a time, if necessary

• Stay activeReturn to what now

The road to recovery

Activity

Health

Wellbeing

Time

Don’t try to

burst

through the

pain barrier

– to it not

through it

Pain

will just

push

back

Instead

just give it

a nudge

Pain line

Activity line

Expect to

hit stormy

conditions

In time you’ll notice:

you can do more,

Pain ⬇ problem

⬆ confidence

⬆ optimisim

Acceptance

Adjustment

Activity

Thoughtless, fearless

movement….

Return to what now

Thanks for usingMy Back Pain Journey

Creator: Paul Lagerman

Further watching

Explaining pain in less than 5 minshttps://youtu.be/C_3phB93rvI

Low Back Pain: DocMikeEvanshttps://youtu.be/BOjTegn9RuY?list=PLduSqEwSaqmLRL84vq52KyNzcjhaRwy_c