Chronic low back pain continues to perplex and confound patients and health care providers alike. The field of health care is now calling for treatment based on scientific evidence of its effectiveness. Groups of experts are getting together to search the literature for enough evidence to support one treatment over another.
Recently, a large multidisciplinary panel of back pain experts was gathered together by the American Pain Society. Their task? Review all published randomized trials looking for evidence to help them draft some guidelines for the treatment of chronic low back pain. Efforts of this type are appreciated by those who work with chronic low back pain patients. Instead of everyone spending hours sorting through all the studies trying to make sense of them, experts in the field get together and perform the task, making summary recommendations for all to use.
This group focused on three areas: interventional diagnostic tests and therapies, surgery, and rehabilitation. Interventional refers to more invasive efforts to find out if specific musculoskeletal structures (e.g., joints, disc, muscles, ligaments) are causing the patient’s pain. The theory is that if areas can be targeted as the main cause of the problem, then more effective treatment can be directed at that area.
They came out of the review process with eight strong recommendations. The evidence reviewed showed a clear benefit of some treatment approaches that was greater than any potential harm or burden. But there were also some treatments that lacked evidence for or had enough evidence against them to recommend against their use.
Recommendation 4 may shed some light on your father’s situation. It says that nonradicular back pain responds as well to conservative (nonoperative) care as it does to surgery. Nonradicular low back pain refers to back pain caused by something other than pressure on (or irritation of) the spinal nerve roots. Surgery is considered a low-priority option for patients with this diagnosis.
Patients considering surgery should be told about the risks and possibility that the results will be less than satisfactory. Patients go into surgery thinking that they will wake up pain free and that just doesn’t happen. Risks for surgery with complications and cost make this option less than attractive for many people once they understand the big picture. Intensive interdisciplinary rehabilitation or other alternative treatment options are always recommended first before surgery.