Psychological factors play an important role in the development of chronic low back pain (LBP) and associated disability. Factors identified include interpreting pain as a threat, paying too much attention to pain (hypervigilance), increased pain sensitivity, difficulty ignoring pain and poor cognitive coping strategies. A recent article “Easy to harm, hard to heal” explores attitudes, beliefs and perceptions related to LBP (1). Key themes to emerge was the back is vulnerable to injury, there is a need to protect the back by resting, LBP is difficult to understand if you haven’t experienced it and LBP has an uncertain prognosis. Unfortunately these negative beliefs do not accurately represent the back.
However the key themes indicate there is an attentional bias toward information which demonstrates that the spine is vulnerable and some activities are dangerous, as well as toward information indicating that back pain is serious or the pain will persist. Some key positive messages should include LBP has a good prognosis and resuming normal activity as soon as reasonable is advised. Also the back is a strong structure and pain does not equal harm.
The chance is a spontaneous regression (healing). 43% of sequestrated disc completely resolved at follow up, compared to only 15% of extruded discs. While the disc showed good ability to recover it is not well correlated with a better clinical outcome. Conversely clinical outcome can improve even without disc size regression. Another point of interest is most spontaneous disc regression happened within the first year and could be observed within the first 2-3 months.
The key clinical message here is lumbar disc herniation can improve or disappear spontaneously without surgical intervention. Long term results of all randomized controlled trials support that surgery (fusion) is no better than non-operative care in improving pain and disability in chronic LBP (3). The vast majority of people with leg pain (sciatica) will have a good outcome with conservative care.
At Central Bassendean Physiotherapy we pride ourselves on our accurate diagnosis and evidence based management of LBP. We are happy to have a further discussion on the material presented here or provide the references. You can BOOK HERE or Call us to make an appointment at 9279 7411
1. Darlow BP, Dean SP, Perry MP, Mathieson FMA, Baxter GDD, Dowell AM. Easy to Harm, Hard to Heal: Patient Views About the Back. Spine. 2015;40(11):842-50.
2. Chiu C-C, Chuang T-Y, Chang K-H, Wu C-H, Lin P-W, Hsu W-Y. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-95.
3. Mannion AF, Brox J-I, Fairbank JC. Consensus at last! Long-term results of all randomized controlled trials show that fusion is no better than non-operative care in improving pain and disability in chronic low back pain. The Spine Journal. 2016;16(5):588-90.