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A Free, World-Class Booklet on Understanding Your Back Pain

Many patients with a first episode of back pain have a desire for useful information. What is known about the condition? What is causing my back pain? Do I need a scan?

Unfortunately, the internet abounds with information about back pain. Much of the information is conflicting or difficult to understand. Keeping in mind that our understanding of the condition is evolving, there are some things that research scientists, clinicians and best practice guidelines offer you about the condition. The booklet here is based on up to date information for you:

Many low back injuries are soft tissue injuries: strains and sprains. Similar to an ankle sprain, you can sprain your back. A variety of lifestyle factors can predispose you to these injuries. Feeling stressed, tired, or generally unwell may play a role. Also, your general fitness levels may be a factor.

Less than 1 in 100 cases of low back pain are due to serious causes. Serious causes such as infection, cancer, or cauda equina syndrome are usually obvious to clinicians, and they will screen you to determine if you need a referral because of a serious condition.

Back pain can feel very frightening and it can be intense; however, this is not necessarily a good indication of how serious the condition is. In fact, most back pain, even if severe, will improve with time. It may require some advice, over the counter medication, or some analgesics from your GP. You might find a heat pack is helpful. Some patients find they benefit from dry needling therapy, or others will benefit from spinal manipulation, and others improve with stretching and exercises. Simply seeing a clinician who is able to rule out any serious cause of your back pain, and who can provide you with reassurance that your condition is not serious can be very comforting to patients.

We have improved our understanding of pain in recent years. For example, your brain can turn the pain up or down based on a variety of things. Simple things, such as sleep, exercise, and reducing stress are very beneficial. Furthermore, movement is key. It will be important for you to find ways to move. Even if it causes some discomfort, movement and activity are part of the process of getting better. Simply put, don't rest too much and wait for the pain to disappear prior to doing some activity; activity is part of what will get you better (even if it's a little uncomfortable doing so)!

Lastly, many people with low back pain think they need imaging. They also know someone who had back pain...and they got imaging. Will this help you? As counter intuitive as it may seem, the answer seems to be no. Multiple studies have shown that imaging does not improve patient outcomes. In fact, it may worsen your outcomes. Why? Well, if you get imaging, certain changes are guaranteed to show up. But 6 out of 10 people will have changes on their images that show up, even if they DO NOT HAVE PAIN. It may be better to think of some of these as normal, age-related changes (similar to grey hair).

Furthermore, for most back pain, early imaging doesn't change your management strategy or options. Since the majority of people will improve in a few weeks time, it is often best to see how your body copes. Early intervention doesn't lead to better outcomes. In fact, early intervention, and early advanced imaging, can often times lead you to seek more care, such as surgery, opioids, and other options that are now classified as low value.

It is important to remain optimistic about your condition. Having the facts about back pain can go a long way towards a good recovery. Reading the above booklet is a good place to start.

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