FEATURE coughing too hard, in Furlan’s case. Often, it goes away after a couple of weeks. But about 10 to 15 per cent of the time, the pain lingers for months, potentially developing into chronic pain. And in some people, the pain comes back again and again over the years, for no clear reason. Clinicians still know very little about why or how acute pain leads to chronic pain. And once the pain becomes chronic, they know very little about how to treat it. In addition to that knowledge gap – or perhaps because of it – there’s a real tendency on some patients’ parts to perceive the pain as a lifelong disabling condition. Overtaken by discomfort, people with low-back pain will often consider an array of treatments – including some with questionable evidence. As one retired nurse from Hamilton, Ont., puts it, “I’ve tried physiotherapy, exer-cise, acupuncture, a TENS unit, a body cast. If it was available, I’ve tried it. I will admit I even had a laying on of hands.” To Furlan and her fellow researchers at the Cochrane Back Review Group (informally referred to as the Back Group), that desperate need among patients and clinicians for guidance about how to treat or cope with back pain is what drives their research agenda. Celebrating its 15th anniver-sary this year, the Back Group was set up to bring forward evidence-based health interventions for neck and back pain and other types of spinal disorders (though fractures and inflammatory diseases are outside its scope). Hosted by the IWH in Toronto, the Back Group is one of 53 groups that make up the Cochrane Collaboration. The Collaboration is an international effort to improve health care by shining a light on the best evidence available. It, too, is celebrating an anniversary this year – its 20th. “In the early years, our work was very much about sorting through the weak-nesses in the literature on this condi-tion,” says IWH senior scientist Dr. Claire Bombardier, who co-founded the Back Group along with the world-renowned Swedish orthopedic surgeon, Dr. Alf Nachemson. “The literature at the time was very compart-mentalized. It had a very surgical www.canadianchiropractor.ca PAIN mANAgEmENT They’ve got your back Systematic reviews build a better understanding of pain I by uyen Vu uyen Vu is a communications associate at the Institute for Work and Health and editor of the Institute’s newsletter, At Work. She can be reached at [email protected]. For more on the Institute, go to www.iwh.on.ca. 38 Canadian Chiropractor December 2013 Photo: fotolia.com t’s difficult for people to understand how debilitating back pain can be until they experience it. Andrea Furlan had a first-hand encounter with it last spring, and despite her many years of researching and treating the condition, the episode was eye-opening. “The pain was constant. It was hard to sit, but it was also hard to move,” says Dr. Furlan, an associate scientist at the Institute for Work and Health (IWH) and the new coordinating editor at the Cochrane Back Review Group. She had to keep a sense of panic in check. Once she ruled out more serious problems by completing a diagnostic tool, she tried not to think of the pain in catastrophic terms. “I had to remind myself that the acute pain will eventually go away,” says Furlan. “I knew this, but it didn’t make it feel better.” The episode was a powerful reminder of the potentially life-altering impact of pain. Back pain is one of the most common health problems in industrialized countries, but it’s also very misunderstood. About eight in 10 people in industri-alized nations are expected to experience low-back pain at some point in their lives. Pain in the lower back is sometimes caused by an ordinary activity – like
Chiropractic + Naturopathic Doctor December 2013: Page 38
