Low back pain research project for self management

Aim

Identify the key features of inflammatory versus mechanical low back pain to inform sufferers of simple effective self management

Low back pain is estimated to affect in the region of 577 million people worldwide, affecting women more than men. It is the number one musculoskeletal problem in the world and in spite of extensive ongoing research is still on the increase.

I have been working as a musculoskeletal physiotherapist for over 30 years and have found that identifying whether someone's simple low back pain is predominantly inflammatory or mechanical can lead to relatively simple self management strategies. These can result in 70-80% improvement overall with improvements in mood and improved ability to carry out normal daily tasks in a relatively short time. These strategies also help to reduce the recurrence rate of low back pain and reduce the frequency, severity and duration of recurrent episodes, improving sufferers quality of life.

This study is to determine the most important signs and symptoms that indicate the presence or absence of inflammation, guiding both practitioners including GP's, First Contact Practitioners Physiotherapists and anyone working in Primary care who deals with people with this condition. More importantly as it is getting harder to access healthcare at times, sufferers can use this information to carry out simple effective treatment themselves which is very low in risk to alleviate and treat their condition initially.

This research project is to clarify the relevant clinical features of inflammatory versus mechanical low back pain which following precautions and contraindications is the second most important question to answer to determine what the initial treatment should be, for this condition and so far has not been fully investigated and determined. For the 85-90% of people with simple low back pain this is a key determinant of their treatment and answering this can lead to safe simple effective treatment that can substantially relieve their symptoms and improve their function as well as giving them a sense of control over their condition with relatively simple tools and exercises. It is acknowledged that roughly 12% of cases are more complex and may lead to ongoing persistent pain and may require a biopsychosocial approach and even some form of psychological intervention as well to aid these people with this condition. However even in these cases the treatment strategies that follow on from determining whether it is a inflammatory or mechanical (pain mechanism) can still be very helpful and in some cases may help to prevent the condition from becoming persistent. As part of the research study we will be monitoring for this possibility in our participants and advising them accordingly if it is required. for their benefit. 

85-90% of low back pain is termed simple low back pain, (localised to the back area) with no discernable structural pathology or nerve involvement. The natural history of low back pain once it starts is that it tends to become recurring, coming and going, and needs to be managed over time. A previous study I carried out showed that for patient's with an inflammatory component once this had settled, people with the condition reported feeling overall 70-80% improved, with improved mood and improved ability to carry out their daily tasks and recover the majority of their function. Other studies have also shown that using relatively simple exercises the recurrence rate of low back pain can be reduced from 80% to 30% and clinically what I have found is that episodes are less frequent, resolve much more quickly and are less painful, enabling people, with the condition, to self manage themselves very successfully. This can be achieved in many cases with relatively simple home treatment and simple exercises that require no equipment of any kind. It can also help to indicate that if these simple strategies do not work that further assessment and treatment are required by a suitably qualified professional ranging from physiotherapists through to Consultants for further examination and treatment. In this time when it is increasingly difficult to see a GP and gain access to health services many patient's now do not go to their GP regarding this condition as they feel that it is not helpful and studies have shown that patient's that do visit their GP who do not improve simply stop attending their GP, for this, and continue to suffer even 1 year later in 40% of cases.

This study is to be carried out in a University in London, using assessment of simple low back pain patients, their clinical features ( signs and symptoms) as would be normally assessed in a physiotherapy examination, a blood test to measure suitable biochemical markers of inflammation and quantitative sensory testing ( a battery of validated tests examining characteristics of nerve function in different pain states). These test results will be analysed to determine the most important and useful clinical features indicating the presence or absence of inflammation that directs the most relevant treatment at that time for that patient's condition. The results of this study will be shared / disseminated as widely as possible to both professionals and the public, both here and worldwide to enable the maximum number of people who suffer with this condition to benefit from the relatively simple, extremely low risk strategies to manage this condition when it is present and to reduce the recurrence of episodes in between episodes.

It will also indicate that patient's / sufferer's that do not respond to these simple self management strategies should seek help from qualified professional practitioner's ( GP's, First Contact Practitioner's, Physiotherapists, Osteopaths, Chiropractors and in some cases Consultant's) and may require additional treatment and / or investigations to determine the best treatment for their particular condition.

This project closed unsuccessfully on 9th May 2023