The burden of spinal pain and disability

19 October 2021

Scott Buxton, a physiotherapist from our partner Physiopedia, talks to us about the burden of spinal pain and disability around the world on World Spine Day. 

Saturday the 16th of October marks annual World Spine Day. This year’s theme is back2back.The theme focuses on the need to readjust the way we think about back pain. Low back pain in particular is one of the leading causes of disability worldwide and is often associated with costly, unhelpful and sometimes harmful care. 

Part of the challenge rehabilitation professionals face is an uphill battle against the mountain of misinformation and stigma associated with all types of back pain. This challenge isn’t unique to low- or middle-income countries as access to quality spine care and rehabilitation is a common challenge for us all. However, lower income countries face additional barriers in the resilience of health systems and their ability to adapt to growing rehabilitation needs – something the ReLAB-HS project is working hard to address, which should see improvements in care for those with back pain in the future.

In higher income settings there is over reliance on medical imaging despite there being decades of evidence highlighting the poor correlation between imaging and diagnosis. Spines often look worse than they are when you put them through a scanner meaning ‘red herring’ diagnoses are often made, which reinforces bad habits and raises false alarms. Rather than striving to follow suit, lower income settings may need to question how limited resources should best be spent to optimise patient outcomes – recent research in this area, which addresses the additional challenges resulting from the COVID-19 pandemic with evidence-based solutions, should be at the forefront.

Think of it this way – spinal pain is extremely personal and multi-factorial, meaning there are lots of muscles, bones and nerves which contribute to pain, as well as other psychological and social factors, and it’s often too difficult to know which and how many factors are specifically causing the pain. Current best practice in pain acknowledges the important role that a whole variety of stressors play in all pain presentations. X-rays and MRI scans are great at looking at part of the picture in detail but often not the whole picture. Meaning that a light is shone on part of the spine which could be contributing to the problem but we interpret this as the sole problem, rather than taking a holistic approach.

Simply put – many ‘obvious’ problems that scans reveal aren’t actually problems. This is demonstrated by the fact that not only do more than half of ‘slipped discs’ get better on their own without intervention – it’s the worse ones which are more likely to get better on their own. Persistent pain is rarely related to serious tissue damage, but instead may be influenced by any number of factors such as stress, mood and changes in activity.

This appears paradoxical and is inherently difficult to explain to people when they are in the midst of an episode of severe back pain. It’s no surprise that people find it hard to understand that exercise and movement is the best approach when it’s movement and exercise which hurts them the most. This is particularly challenging if support with rehabilitation is not available, and puts the focus on public health advice to improve quality of life. The work ReLAB-HS is doing in our learning countries will help to bring much needed services to many, including those with back pain, by strengthening rehabilitation services and integrating rehabilitation into health systems.