Back pain is a very common presentation for people to seek healthcare. Back pain is also very complex, there are structural, functional, neurochemical and psychosociological reasons why a person develop lingering back pain.
Most episodes of back pain are short-lasting with little or no consequence, but recurrent episodes are common and back pain is increasingly understood as a long-lasting condition with a variable course rather than episodes of unrelated occurrences.
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Prevalence Of Back Pain In Australia
- About 4 million people or 1 in 6 Australians (16%) had back problems in 2017–18
- In 2015, back pain was the 2nd leading cause of disease burden, accounting for 4% of Australia’s total disease burden
- In 2017–18, there were 181,000 hospitalisations for back problems
Low back pain is a complex condition with multiple contributors to both the pain and associated disability, including psychological factors, social factors, biophysical factors, comorbidities, and pain-processing mechanisms.
Lifestyle factors, such as smoking, obesity, and low levels of physical activity, that relate to poorer general health, are also associated with occurrence of low back pain episodes
For nearly all people presenting with low back pain, the specific nociceptive source cannot be identified and those affected are then classified as having so-called non-specific low back pain.
There are some serious causes of persistent low back pain (malignancy, vertebral fracture, infection, or inflammatory disorders such as axial spondyloarthritis) that require identification and specific management targeting the cause, but these account for a very small proportion of cases.
The combined effect on individuals of low back pain and comorbidity is often more than the effect of the low back pain or the comorbidity alone and results in more care, yet typically a poorer response to a range of treatments.
Hence, when we looking at the targeted pain mechanism to treat the back pain, we should consider the following:
- Nociceptive: Tissue Injury e.g. intervertebral disc, facet joint, vertebral endplates (Modic changes)
- Neuropathic: Nerve Injury e.g. nerve impingement, radicular pain (sciatica), post-surgical pain, central stenosis
- Nociplastic: Sensitised Nervous System e.g. nonspecific low back pain, fibromyalgia