Twenty-five years ago, the focus shifted from looking for a specific pathologic reason for low back pain to an understanding of the biopsychosocial factors accompanying back pain. By then, it was clear that finding a clear and accurate diagnosis to label each patient was often impossible. Imaging studies with X-rays, CT scans, and/or MRIs are often “negative” (no findings of anything “wrong” in the bones or soft tissues).
Stress at home and at work, feelings of being out of control of life situations, and self-perceptions were some of the biopsychosocial aspects mentioned at that time. An awareness that treatment at that time was driven by patient complaints, distress, and behavior started to change things.
There was a shift toward emphasizing ability (function) rather than disability (limitations). Instead of focusing treatment on pain relief, rehab programs today aim to improve flexibility, endurance, and strength in the presence of ongoing pain. If pain is relieved, well then, so much the better. But pain relief is no longer the main treatment objective.
Recovering function (daily activities) and the ability to return to work are the main goals of today’s treatment for chronic low back pain. This approach is referred to as the Goal Achievement Model for the treatment of low back pain. Efforts to reduce disability from back pain based on patient goals is a new way of thinking about the problem of back pain.
Concepts such as setting “acceptable targets” and forming “patient-based action plans” are the new words attached to current treatment ideas about chronic low back pain. Health care providers can still use the biopsychosocial model (working with patient values, attitudes, and beliefs) while the patient gets the results he or she is after. This approach has worked quite well with other health problems (mental health and chronic diseases that lead to severe disability).
Pain can be a real deterrent to accomplishing anything from the simple task of brushing your teeth to getting a good night’s rest. Clinical and research efforts are underway in an attempt solve the dilemma of chronic low back pain. In today’s modern practice, you can expect to find yourself in a goal-oriented program that takes into consideration physical, emotional, psychologic, social, and spiritual aspects of care.
Lowering costs, meeting patient expectations, and providing successful outcomes and patient satisfaction are all important but complex factors that must be taken into consideration. Pain relief is part of that approach but only a small piece of the pie. Give this approach a fair try and see what you might be able to accomplish in the long-run rather than having a short-term focus on pain relief. It can be a challenging way to treat back pain (for the patient!) but still very effective.