Importance of Recognizing Back Pain that Requires Specialized Care

Back pain is one of the most common chronic pains in the Western world. It's estimated that just about everyone will complain of some sort of back pain at some time in their life. Researchers who are looking for ways to manage and prevent back pain also are trying to find how to prevent uncomplicated back pain from becoming chronic back pain - pain that lasts for more than three to six months.

In one study done in France, by Celine Bouton, MD and colleagues, the files of 72 patients with chronic back pain were reviewed. The patients had experienced their back pain for an average of 85 to 86 months and had been treated for about four years by their own doctor. For treatment, the patients had tried using analgesics (pain relievers) from over-the-counter to opioids (controlled medications, like morphine), and anti-depressants, which do help many people with chronic pain. The patients also tried physiotherapy, saw a rheumatologist, and/or had surgery for their back pain. Many of the patients were unable to work.

The researchers pointed out that the time from injury to the time the patients were seen by a multidisciplinary approach, a team of health care professionals from different aspects of medicine, was long and that this is one of the issues that patients often face. The researchers wrote that general practitioners need to be encouraged to refer their patients with back pain earlier rather than later.

There are some guidelines regarding referring patients who have back pain that hasn't responded to traditional, non-invasive (non-surgical) treatments. Generally, if there doesn't appear to be a good recovery within six to 12 weeks of the original injury, the patients should have a thorough assessment, according to the Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project.

One of the problems that block referrals for back pain is that chronic back pain isn't a red flag in many situations. So many patients who have chronic back pain do visit their doctor that it's considered to be one of the most common complaints seen in the doctors' office. It might also be that it's hard to tell the difference between common back pain and back pain that is caused by something more serious. It's the more serious back pain that can develop into severe and debilitating problems if not identified, though.

Primary care doctors are considered to be the gate-keepers of the medical system. It's through them that patients are assessed, treated, or referred on for further, more specialized care. This is also true for back pain. What adds to the problem is that there isn't a lot of access for patients who require specialized back care, so the doctors are having not only to recognize when a patient needs referral, but to find someone who the patient can be referred to.

The Road Home for Those With Complicated Back Pain. In The Back Letter. November 2008. Vol. 23. No. 11. Pp. 122.

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