Back pain is common
There is an 80% chance that you will develop back pain at some stage in your life. One in six Australians experiencing back pain. The older you are, the higher the risk.
Back pain is one of the most common reasons people see their doctor and take time off work. It is also a leading cause of disability around the world.
It is associated with chronic disease. Back pain is also linked to ageing, lack of physical activity and being overweight.
Back pain is expensive to treat
Back pain is a massive health budget drain with Americans are spending 50 billion a year and Australians are spending $2.8 billion a year treating it.
Back pain represents 23% of disease expenditure on Musculoskeletal conditions and 2.4% of total health expenditure.
Government health spending grew 74% over the past decade, far faster than GDP, which grew by 46% above CPI
In 2016 – 2017 in Australia, there were 175,136 hospital stays with the principle diagnosis of back pain.
Surgical treatments can have poor outcomes
Surgery has such poor outcomes, that it even has it’s own acronym – FBSS or failed back surgery syndrome. There is no equivalent in other surgical procedures such as cardiac surgery or knee replacements.
One study in the USA showed that over a ten year period the number of spinal surgeries quadrupled, however the failure rate was between 10% and 46%.
In 2017 another study showed that up to 74% of low back spine surgeries fail to completely relieve pain.
One large study showed that
…11 percent of the spinal fusion patients had permanent disability, compared to the 2 percent of patients treated without surgery.
The anatomy of the spine
The spine is a lightweight and flexible structure. It was designed to allow slim people living into their forties, to hunt and forage for food, climbing, running and swimming.
The human spine is composed of 30 small bones (called vertebrae) all stacked one on top of the other. These bones are separated by spongy pieces of cartilage, called discs, that act as shock absorber. With age these discs can wear, shrink, or become injured. The heavier a person is, the more pressure gets placed on this delicate spine structure.
A weakened disk can rupture, allowing the soft inner material to protrude. These leads to a herniated disc.
The physiology of pain response to treatments
The resulting nerve pain is very different to other types. It is often described as being sharp, burning or stinging. People sometimes describe shooting pain as being like an electrical shock.
Neuropathic pain does not respond to opioids like other forms of pain.
One of the few successful pharmacy treatments are anti epileptic drugs that work by altering and reducing excessive electrical activity in nerves. These drugs are used with good success in chronic nerve pain conditions like Bell’s Palsy.
Other drugs that can be extremely effective against nerve pain are anti inflammatory drugs. Pain triggers the release of enzymes which cause tissue inflammation, which in turn increases the pain. Anti inflammatories stop this process and help decrease pain.
Another successful approach is using Transcutaneous electrical nerve stimulation or TENS. This is where a low voltage electrical current is given to the skin, over an area where chronic pain is felt. This can scramble pain signals, distracting the chronic pain pathways.
Encouraging people to exercise areas that have pain can also ‘trick’ the brain, causing it to focus on controlling movement and therefore reducing the nerve activity sending pain signals.
Articulate labs – A ‘smart knee’ rehabilitation device that gives out electrical impulses, to increase muscle tone.
BetterPT – A physical therapists directory, that shows the nearest clinics, ratings and reviews.
HingeHealth – Improving chronic back and knee pain without drugs, with app based exercise therapy, behavioural coaching and education.
Jintronix – Home based therapy using smart wearable devices and screen based feedback.
Kaia health – an app offering 250 exercises that can be tailored for personalised back pain relief.
Kieser – gym equipment and physiotherapy programs designed specifically for rehabilitation and back management.
Lark – personalised health and fitness program using artificial intelligence and smart devices.
Neofect – smart rehabilitation for neurological and musculoskeletal conditions.
Online physio – Allows users access off site physiotherapy conferencing, to receive individualized assessments and treatment plans.
Physera – App based physiotherapy program, from teleconferencing to individual plans and ongoing monitoring.
Physitrack – a platform linking physiotherapists to customers for online assessments, treatment plans and ongoing follow up.
Reflection Health – remote physiotherapy program.
Sword health – pairing physical therapists with home based clients, so they can make an assessment, recommend treatment then monitor progress, from wearable motion sensor trackers and digital therapy programs
Theratrak – an app platform to allow physiotherapist to communicate digitally with their customers.
ThereTrak – A smartphone app that allows physiotherapists to capture meaningful data from clients and then prescribe and monitor personalised rehabilitation programs.
XR health – using Virtual Reality technology to deliver home based rehabilitation programs
Take home message
Chronic conditions like many forms of back pain, should be treated first by allied health professionals and last, by medical intervention.
The most effective treatments may be a coordination of allied health services, from psychotherapy to dietitians, to help people lose weight, exercise and find the treatments that work for them.
There is no ‘cure’ for getting older. It’s simply a byproduct of living longer due to better hygiene, antibiotics and medical treatments for acute conditions. We need to manage old age, not ‘treat’ it like a disease.
All About Neuropathy And Chronic Back Pain – Spine health, William Deardorff, PhD.
Causes of FBSS: Why Does Back Surgery Fail? Very Well Health 2019
Failed Back Surgery Syndrome: A Review Article – Asian spine, 2018
Healthcare costs unsustainable in advanced economies without reform – OECD 24th September 2015
Tough choices: how to rein in Australia’s rising health bill – The Conversation 2013
© Wikihospitals October 2019
Tough choices, how to rein in Australia’s rising health bill.
Health costs are rising inexorably across the Western World.
Causes include :
- Ageing populations (the average life expectancy was around 50 at the turn of the century. It is currently around 80 years).
- The rise of unhealthy lifestyle diseases like obesity due to sedentary lifestyles and processed, sugary food (obesity rates have tripled since the 1980’s).
- An outdated health payment system that generously rewards expensive medical treatments in hospitals, while underfunding cheaper, primary care (it costs up to four times more to treat someone in an Emergency Department than it does with a General Practitioner in the community).
The biggest and fastest growing category in the health budget is hospital spending. However hospital treatments are less successful than many people realise.