"When will this pain go away?"
You may have wondered this if you've ever had days of agonising low back pain for no clear reason.
The condition is a leading cause of disability but it's often hard to pinpoint why the pain has erupted, with 90 per cent of low back pain cases not linked to a disease or physical injury.
This makes it difficult for people to know how long they'll be doubled over for.
Enter a team of Australian researchers who set out to figure out when you can expect to feel some relief.
They say we need to rethink the idea most people with a new episode of low back pain will get better within two weeks.
They also suggest the outcomes for people with chronic low back pain are less optimistic than we previously thought.
Relief after six or 12 weeks likely
Low back pain can feel like a dull ache or sharp pain and can radiate into other parts of your body, like your legs.
Sometimes it's due to a fracture, muscle tear or a condition like arthritis but in most cases, it's completely inexplicable, or in medical terms, non-specific.
By analysing around 20,000 people from around the world, University of South Australia researchers found 70 per cent of people who have non-specific acute low back pain will recover within six weeks.
Of those who are still in pain after the six-week mark, around 70 per cent will have improved after another six weeks — so that means roughly 90 per cent of people have improved after three months.
"So a lot of back pain will take care of itself and we won't ever know why it started," lead researcher and professor of clinical neurosciences Lorimer Moseley tells RN's Health Report.
Loading...It's not such a pretty picture for those who are still in pain after three months though.
The researchers found these people often still have moderate to high levels of pain and disability by the 12-month mark, noting however, that the available data on this is limited.
"Once you've got chronic back pain, it tends to hang around," Professor Moseley says.
"Recovery rates are much lower once it's been around after three months."
But Professor Moseley says we still aren't able to reliably predict who will recover after six weeks and who won't.
"We do know things that will change your likelihood of recovering though."
Why some people develop chronic pain
Your age and gender can put you at higher risk, with older women more likely to progress from acute to chronic low back pain.
The same applies if you're from a non-English speaking background or have lower socio-economic status.
Other risk factors may include:
- High levels of fear or anxiety about feeling pain
- Low self-efficacy (the belief that you can achieve a desired outcome)
- Stressful life events around the time the condition begins
- Depression
- Higher body weight
But Christopher Maher, director of the Institute for Musculoskeletal Health, says these predictors aren't always reliable and are mainly things people can't change about themselves.
"So we're better off looking at the things we can control."
Treating back pain
If you've got acute low back pain — which can last for a few days or up to three months — the best advice is to avoid bed rest and keep moving.
Professor Maher recommends seeing your doctor so things like fracture can be ruled out, but most people will be told to gradually resume normal activities and get relief by applying heat.
If things don't improve in a couple of weeks seeing a physiotherapist may be advised.
But for chronic back pain, treatment often involves the mind as well as the body.
If you've ever had an episode of back pain you might have caught yourself telling people "Oh, I've put my back out".
But Professor Moseley says we need to change this thinking as back pain is often not linked to a physical injury or pathology.
"We've got to get rid of the idea of things being 'wrecked' because with most back pain, nothing is wrecked."
Falsely believing you have sustained some anatomical damage, like a slipped disc, can make you scared to move and lead to negative beliefs about your recovery.
And research has shown the expectation of pain can increase the perceived intensity of pain.
Sensorimotor retraining focuses on pain education, as well as improving tactile acuity, which is all about how precisely you can identify touch on the body.
Chronic pain can make it difficult to pinpoint where you are being touched on the back but refining this can improve information processing between the back and brain.
This is important as most people with chronic pain have what's called pain system hypersensitivity which means their nervous system senses pain in harmless situations.
Two Australian clinical trials on low back pain, called Resolve and Restore studied sensorimotor retraining and a similar treatment called cognitive functional therapy with positive results.
In the Restore trial, people who underwent 12 weekly clinical sessions with physiotherapists trained in cognitive functional therapy (CFT) saw bigger reductions in pain and disability than those who underwent standard physio sessions.
More than 80 per cent of participants said they were satisfied with the the CFT treatment.
Making new treatments a reality
Interventions that work are available, but we're just not getting them to the people that need them, according to Professor Moseley.
That's partly, he says, because there aren't enough physiotherapists trained in how to provide these programs.
The other issue is Medicare doesn't cover cognitive functional therapy or sensorimotor retraining.
That's despite the Restore trial finding the technique costs less than standard treatments for back pain and produce an economic benefit of $5,000 per person over a year (mainly thanks to increased work productivity).
While people who've been in pain for longer than six months can get up to five subsidised sessions with an allied health professional if their GP has created a chronic disease management plan, Dr Maher says that's not enough to cover the new programs which require between 8 and 12 sessions to be effective.
"Even if the person has the full cap of five available the person cannot access these programs via Medicare. The cap is frustrating for the GP, the patient and physio," he says.
"It would really be worthwhile the federal government investing in this ... but at the moment they're reimbursing people for things like spinal surgery or spinal cord stimulators or opioids which are all pointless."
Research has shown placebos are no more effective than opioids at relieving back pain and surgery is no longer considered best practice.
Professor Maher says new treatments present an opportunity to improve the lives of many Australians and overturn predictions that by 2050 there will be a 50 per cent increase in low back pain cases.
"A lot of people want to push this bad message about back pain but there's really good evidence about what we should be doing, so let's act upon that."