Job satisfaction and a positive attitude are among the strongest indicators of whether back pain will turn into serious disability but their report, published earlier this week, says doctors are reluctant to discuss social and psychological approaches, preferring needless scans.
Back pain is the world’s leading cause of disability, with up to nine million estimated to suffer from it in Britain and half a billion worldwide, but a series in The Lancet says that it is routinely badly treated. In Britain one in seven GP appointments is for muscle and nerve problems, mostly back pain.
NHS guidelines recommend mainly exercise and therapy, steroid injections are increasing, as are scans that often lead to surgery, a fifth of which actually makes the problem worse. The fact is that the evidence underpinning these invasive treatments is very weak indeed, and they have harms. There are studies showing that a third of British patients with back pain are given opioids such as tramadol, codeine and morphine but that if anything the evidence is that [opioids] can end up making the pain worse.
About 24 million opioid prescriptions are written by GPs each year, double the figure a decade ago. UK Ministers have launched a review into concerns that patients are becoming hooked and suffering dangerous side-effects. Past studies have found that pills like paracetamol and ibuprofen barely help with back pain.
My opinion has been the same for many years; that our belief system and psychological state are important predictors of how severe pain is felt. Physical pain is inextricably linked to our overall health and mental attitude.
This of course all begs the question; why do doctors insist in making potentially wrong prescriptions, and why do individuals and business not pay much greater attention to mental health and positive psychological awareness and training?