A manual for the treatment of back pain

Exactly what to do with pain in the back? A wide range of options is offered for this ‘disease of the century’. In order to help see the trees through the forest, the Federal Knowledge Center for Health Care (KCE) released a clinical standard in May, based upon the most recent clinical evidence.

Now the KCE has actually developed a ‘care course’ that figures out which tests are best carried out for each kind of back patient and which is the ideal treatment. The KCE established an interactive, online tool (www.lagerugpijn.kce.be) for higher benefit.

Exactly what is a care course?

A care path is a kind of route to be followed in which certain research studies and treatments are suggested for a particular patient at a particular stage of his/her condition, so that the technique is as coherent as possible. To put it in a caricature: surgical treatment is not advised prior to aiming to handle pain in the back with physiotherapy.

The standard and the care path were both established in close partnership with the Spinal column Society of Belgium and with representatives of general practitioners, physiotherapists and other practitioners of manual strategies (osteopaths and chiropractors), experts in physical medication and rehabilitation, orthopedic surgeons, neurosurgeons, anesthetists/ algologists (from pain clinics) and psychologists.

Much attention for work-related elements

For the advancement of the care path, the working group also contacted occupational therapists and ergonomists, company medical professionals and recommending doctors of the medical insurance funds. The group wanted to pay a great deal of focus on the maintenance or resumption of the work.

Patients Talk

The clients also took part in the task through focus groups, where they spoke about their sometimes undesirable experiences with the care system. This revealed a variety of basic misconceptions in between patients and caretakers. For example, clients frequently anxiously await an exact ‘medical diagnosis’ of their back pain, while the experience of caretakers is that this discomfort is normally not brought on by a back injury, however by a short-lived dysfunction, which can not be seen on an X-ray or MRI. Imaging is for that reason unneeded and the treatment ought to initially be as little medical as possible. The danger is that patients translate this as nonchalance of the care service provider. A clearer interaction about this is for that reason required.

Prevent the problem from becoming chronic

In about 10 percent of cases, back pain persists for numerous weeks. From 3 months onwards, the discomfort is considered to be chronic. The entire care course is targeted at avoiding this shift to chronicity. A number of widely known threat factors can determine people at danger of persistent discomfort. These aspects are psychological (eg patient is very distressed) and social-professional (eg dispute with the company). In each phase of the care path, this threat must be (re) evaluated, so that the treatment can be adapted to the particular profile of the patient.

The care providers should discover the right balance. On the one hand, they need to dramatize the problem in the bulk of their clients, encourage exercise, do not perform radiographs and prescribe as few drugs as possible. On the other hand, they should identify patients at risk for a chronic and potentially incapacitating problem (10% of patients).