Low back pain enhanced by psychological factors
Psychological and social stressors often enhance the symptoms of low back pain, experts say.
Associate Professors Leigh Atkinson, from Wesley Pain and Spine Centre in Brisbane, and Andrew Zacest from Royal Adelaide Hospital wrote in the Medical Journal of Australia that the high incident of low back pain is best understood in a biopsychosocial framework.
They say the pain from an injury is compounded by other issues such as work dissatisfaction, family stress, depression and at times secondary gain.
Compensation and third party insurance can impact pain and prolong rehabilitation. Furthermore, a study of workers compensation patients receiving surgery found the outcomes were poor.
“The incidence of persistent post-operative pain syndrome was as high as 40% and … there was a 50% success rate, at best, from the first operation, 30% from the second and 15% from the third,” the authors explained.
High expectation of successful surgical outcomes
Low back pain in the most common symptom seen in primary care, however patients often have high expectations from modern medicine.
“Not uncommonly, the patient attends the surgical consultation with an expectation that the problems can be fixed,” the authors wrote.
However despite an escalation in numbers performed, surgeries on low back pain remain controversial.
In the past 11 years, there has been a 267% increase of spinal fusion surgeries in the US and there has also been a disproportionate increase of surgeries in private hospitals compared to public.
There is a large array of techniques for spinal fusion however despite them all having different technical complications, there is little evidence of one providing better outcomes than another.
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Multiple Cochrane studies have confirmed insufficient evidence of the effectiveness of spinal fusions, one in 2005 finding “variable clinical outcomes ranging between 16% and 95%.”
The authors believe an increased there needs to be a national audit of patient centred outcomes for spinal fusion.
“While the spinal fusion procedure remains controversial, it would be valuable for spinal surgeons to undertake a national audit of patient-centred outcomes for the procedure, similar to the excellent audit carried out for hip and knee arthroplasties by the Australian orthopaedic surgeons,” they concluded.