Pain The iNform Way

August 6, 2020

Although pain is advantageous for protection and survival, persistent pain carries no real biological purpose – yet is sadly highly prevalent in the population. I’m not going to dwell on epidemiology. I want to tie in nicely the importance of clinician collaboration as an excellent prophylaxis for acute (and persistent) pain, whilst also discussing a Cochrane review on the lack of evidence of NSAIDs (nonsteroidal antiinflammatory drugs) for the acute management of low back pain.

What are Cochrane reviews?

Cochrane reviews are excellent resources for clinicians (and the general public) to access high quality evidence with iNformed recommendations. Cochrane reviews (or collaborations) involve clinicians/researchers who have excellent experience and knowledge in a specific field. They gather all the relevant research papers on the topic of research (low back back and NSAIDs in this case). They extract all the relevant papers that meet a specific criteria  and make recommendations based on the overall evidence.

The reason why I spent a good paragraph on the aforementioned is that the Cochrane library can be accessed by anyone! Therefore, anyone can seek and critically evaluate a medication (like a NSAID) for example. You can also look at the evidence (for the acute use of low back pain) and come to an evidence based conclusion. As a clinician, providing evidence based care is important for your health and well-being. We call this evidence based care the Science-Practitioner model.

Ok! I’ll provide you a quick synopsis of the paper.

Van Der Gagg and colleagues found: When using a qualitative (self reported) scale for reports in pain reduction, the authors found no statistically meaningful benefits for the use of an NSAID in acute low back pain. A previous Cochrane review in 2014 by the same group came to the same conclusions for the analgesic paracetamol for acute low back pain. These are important implications, as medication may be one’s first choice approach to decrease symptoms. However, with what’s been written and known empirically, what is the best approach to improve symptoms of acute low back pain?

The current evidence suggests that empirical pain education along with graded specific exercise correctives are the current gold standard for the management of acute low back pain. Pain education allows the individual who has pain to better understand it, whilst the clinician being thorough in their examination providing reassurance, and safety to move. We clinicians call this the biopsychosocial model. As the schematic below shows, this is an intricate interplay between tissue, one’s thoughts and feelings, and the environment (potential threats and safety’s).

My premise in this blog is to not overwhelm you with information. More so that there’s evidence out there for you to access. Along with clinicians whose duty of care is to iNform you on the aforementioned publications, and devise an appropriate treatment plan to improve your symptoms. The team at Move For Better Health can guide you safely through your acute pain, whilst collaborating together (Physio, Exercise Physiology, Psychology, Podiatry, Nutrition/Dietetics) in our disciplines with great communication and decades of combined experience.

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