Some good news for America’s Back Pain Problem?

A couple of weeks ago, I had a mock interview for a new research fellowship with our national research council. In my rather sheltered life, these interviews are a rather big deal – whether or not I am to remain a government-funded medical researcher hangs on the line and the chances are intimidatingly thin. The mock interview then, aims to give … [Read more...]

The STarT Back Tool for people with chronic low back pain – strengths and limitations

The STarT Back Tool (SBT)[1] is a 9-item, self-report questionnaire that includes treatment modifiable domains (spread of pain, disability, and psychological factors).[2] It subgroups patients with non-specific low back pain (LBP) into low, medium, and high risk of future disability with the purpose of matching each subgroup to a care pathway. The … [Read more...]

Better than what? Any treatment for back pain can be effective… it might just depend on what you compare it with

Was my treatment helpful, benign or harmful? Consider the common clinical scenario – a patient presents complaining of pain. You decide to administer a particular treatment. Over time the patient’s symptoms improve. Do you then succumb to bias and presume your intervention facilitated their recovery? Do you consider the possibility that recovery … [Read more...]

Take a step back to understand muscle behaviour in chronic low back pain

There is a popular belief that chronic non specific low back pain (CNSLBP) patients need to have higher activation of their trunk muscles during simple functional tasks in order to stabilize their spine. Changes in pain and disability, however, do not seem to be mediated by deep muscle activity changes targeted by some exercise interventions during … [Read more...]

Self-efficacy and paradoxical dependence in chronic back pain

Chronic back pain is one of the most common medical problems patients experience, and it may also be psychologically and socially disabling. People with chronic back pain are significantly more likely to experience depression, anxiety, and other mental health conditions than the general population. I wanted to get a deeper appreciation of how … [Read more...]

Implementation science and its use in low back pain research

The implementation of evidence into practice, even today, where science plays a role in much of our lives, is an elusive task. This challenge in health care is perhaps most vividly demonstrated in the back pain field, where numerous studies show that evidence-practice gaps haven’t improved over the last two decades or more.  Implementation science … [Read more...]

The causes and mechanisms of back pain

For some time, patients, clinicians and researchers have tried to understand the causes of back pain. Theories are abundant, and some have been empirically tested. But to date, the only thing clear is that we’re still unsure about what causes back pain. This uncertainty about the causes and mechanisms of back pain stifles the development of … [Read more...]

LBP in children and adolescents

Is back pain a problem for kids? One of the things that some universities do to help out new researchers is have senior academics look over their grant applications before they are submitted. Recently we had a proposal for a study on back pain in adolescents assessed in this way. One of the comments was that back pain is not a problem for … [Read more...]

Core outcome measures for low back pain

The use of different outcomes across clinical trials on the same health condition may hamper comparability of findings and conduction of meta-analysis. This problem can be dealt with the development of a core set of outcome domains and measures. A core outcome domain is an aspect of health that should be measured and reported in every single trial … [Read more...]

Self-management and behaviour change in persistent LBP: Where is the science currently at?

Background Typically, self-management behaviour change interventions for persistent low back pain (LBP) help the patient to learn and adopt a set of health behaviours that they can use to reduce or manage their symptoms. Although this may seem like a core part of treatment, the effectiveness of self-management interventions for persistent LBP to … [Read more...]