Lower back pain expert: ‘Scans rarely show the cause’

There should be less access to scans and surgery for low back pain, according to an Irish expert in its treatment.
Prof Kieran O’Sullivan, chartered physiotherapist and head of the school of physiotherapy at the University of Limerick, said he would “like to see an audit of scans for low back pain and more guidance to GPs and consultants on which patients to send for scans. I’m concerned that we are spending a lot of money on treatment and scans and the number of cases of low back pain is not reducing.”
Ninety per cent of low back pain is not linked to one specific structural cause (eg a joint, muscle, ligament or disc) and instead is the result of a number of physical and psychosocial factors, according to Prof O’Sullivan. He was speaking to The Irish Times following a webinar on the myths of low back pain. “Scans rarely show the cause of low back pain and so-called ‘abnormal findings’ on scans like disc bulges, disc degeneration and arthritis are common and normal for most people without pain, especially as they get older.”
He said rehabilitation is essential to reassure people. “We need to help them make sense of their pain and support them in their recovery to return to activities they enjoy and maintain independence in daily living.”
While acknowledging that low back pain can be very debilitating and painful, he said the focus for far too long has been on physical and anatomical factors. “We can’t ignore the potential for a serious problem such as a cancer or rare infections of the spine, but 90 per cent of low back pain is caused by a combination of physical and non-physical factors including poor sleep, relationship or family stress, job dissatisfaction or financial pressures.”
He also cautioned people against wasting money on new mattresses, expensive shoes, stand-up desks or special chairs. “You need to know that the pain is worse when lying down or sitting before you invest in these things. It’s really about thinking about the messy stuff such as sleep, stress, energy levels and other health problems,” he said.
During the public webinar, he outlined what he described as the dirty dozen of myths about low back pain. These include “my back hurts a lot so I must have damaged it”, to which Prof O’Sullivan said: “There is lots of pain without injury and low back pain has much more in common with headaches, which we don’t usually associate with injury.”
He also suggested that rather than resting or avoiding carrying or lifting heavy objects to prevent back strain, the best approach is to strengthen the back by finding an exercise that you enjoy and that you will keep doing. “It’s hard to exercise without any pain, but it’s almost always safe to move with low back pain. Motion is lotion and it’s about spending time doing the activity – swimming, pilates, walking, yoga, aqua-aerobics – that you are most comfortable doing and that you will continue to do for a long time.”
To counteract the deeply-held myths about low back pain and change mindsets, Prof O’Sullivan suggested that educational campaigns for both the public and clinicians are needed. “We need to be supportive and not preachy. We need to be patient and not flippant with people to help them self-manage low back pain.
“And nobody recommends strong painkillers for persistent low back pain any more,” he added.