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Psychological issues behind increasing low back pain

Low back pain is the most common symptom seen in primary care; the underlining injury is often enhanced by psychological and social stressors, write the authors of a Perspective published online by the Medical Journal of Australia.

Associate Professors Leigh Atkinson, from Wesley Pain and Spine Centre in Brisbane, and Andrew Zacest from Royal Adelaide Hospital wrote that patients often have high expectationsfrom modern medicine and expect a surgical solution to their back pain.

They explained the high incidence of low back pain in developed countries is best understood in terms of a biopsychosocial framework, in which the pain from an injury is compounded by issues such as work dissatisfaction, family stress, depression and at times secondary gain.

Often compensation system and third party insurance prolongs rehabilitation and extendsrecovery. However, a study of patients receiving workers’ compensation in New South Walesfound surgery outcomes were so poor that the benefits were marginal.

“The incidence of persistent post-operative pain syndrome was as high as 40% and … therewas a 50% success rate, at best, from the first operation, 30% from the second and 15% fromthe third,” the authors explained.

The authors noted a growing tendency for spinal surgeons “to have all patients assessedindependently and, at times, for them to attend an interdisciplinary pain program to clarifyissues of psychological and social origin”.

They also observed that the increased sedentary lives of Australia’s ageing population hasfurther compounded the problem.

“While the spinal fusion procedure remains controversial, it would be valuable for spinalsurgeons to undertake a national audit of patient-centred outcomes for the procedure, similarto the excellent audit carried out for hip and knee arthroplasties by the Australian orthopaedic surgeons,” they concluded.