Low back pain is the leading cause of disability worldwide and 25 to 30 per cent of people with acute low back pain go on to develop persistent and disabling pain. 

Despite the enormous healthcare costs spent on care for people with low back pain, the disability burden is increasing.

Growing evidence suggests that once serious pathology is excluded, the predictors of persistent pain include factors such as unhelpful pain beliefs, over-protective behaviours and pain-related distress. 

Targeting these factors provides opportunities for improving care.

Keynote speaker Professor Peter O’Sullivan will talk about the new approaches to treating low back pain at next month’s Victorian Branch End of Year Breakfast in his presentation ‘Caring for people with disabling back pain—can we do better?’, highlighting the Low Back Pain Clinical Care Standard, which advocates a shift towards active approaches to support Australians with low back pain.

Peter is one of the members of the working group for the Low Back Pain Clinical Care Standard, recently published by the Australian Commission on Safety and Quality in Health Care. 

His research at Curtin University focuses on the development and targeted management of persistent musculoskeletal pain disorders. 

With his team, he has developed a management approach for disabling low back pain called cognitive functional therapy.

Peter says that physiotherapists have an opportunity to lead the way in the provision of better care for people with low back pain, reducing their disability burden. 

However, in order to do this, he says, multi-level system change is needed.

‘As a society, the way we often manage back pain is not helpful and the disability burden is getting worse,’ he says. 

‘There are a lot of concerns about the way back pain has been managed and misconceptions about the causes of low back pain.’

In fact, only a very small percentage of people who present have serious pathology, but because they are referred to imaging, patients with low back pain are often given diagnostic labels that lead to unhelpful care.

‘Many people end up getting imaged for their backs and are given diagnoses like degenerative discs, disc bulges, fissures or arthritis and it leads them down this path of over-protecting the back, changing their posture and trying to be careful about how they move, and avoiding activity which actually makes the problem worse,’ Peter says. 

‘That’s where the clinical care standard comes in. 

‘It provides a pathway for better care to help patients manage low back pain episodes early and to reduce their chance of ongoing problems.’

In addition to the over-scanning of patients with low back pain, too many patients become dependent on opioids and there is too much surgery.

Professor Peter O'Sullivan will talk about the new Low Back Pain Clinical Care Standards at the Victorian Branch Breakfast on 25 November.

‘Physiotherapy plays such a key role in the health space for an alternative pathway for these patients. 

‘We need to be equipped with knowledge, skills and understanding to do that,’ Peter says.

The Low Back Pain Clinical Care Standard provides recommendations for improving clinical management, including better examination and screening of patients, both to rule out serious pathologies and to identify psychosocial factors that might predict poor outcomes, such as patient beliefs, anxiety, stress and depression. 

Education of patients to increase understanding of their condition and to better support self-management of back pain is another important step.

‘The majority of acute back pain will get better with the right care. 

‘The predictors of poor recovery are not what you might see in the scan. 

‘They’re things like becoming over-worried, over-protective and fearful or avoiding movement and exercise. 

‘By guiding patients onto a self-management pathway, we can build their confidence in engaging with movement and activity and getting back to work, which is really important,’ Peter says.

It’s also important to know when to seek a second opinion.

‘If those people are not responding to care, don’t hang onto them; get a second opinion. 

‘That might be from another physiotherapist or a specialist physiotherapist or, if appropriate, a psychologist or back to the GP for additional support with pain management,’ he says. 

‘It sounds simple but it often doesn’t happen.’

Peter says the intent behind the clinical care standard is to have common messaging across healthcare, not just physiotherapists but GPs, surgeons and so on.

‘We all have a place and a role to play and we communicate clearly with people within our care team,’ he says.

Peter believes the new clinical care standard is also more broadly applicable.

‘The standard is a road map for back pain but it’s also a road map for good care for any health condition. 

‘There are fundamental principles that should underpin good care. 

‘Patient-centred care or person-centred care is key. 

‘We should consider the whole person—their concerns, their worries, their goals, their motivations—and make sure we are effective in the way we communicate with them, screen them for pathology, make sure that if they’re distressed or there are other factors going on that we’re alert to it. 

‘Where necessary, we cross-refer them,’ he says.

‘Caring for people with disabling back pain—can we do better?’ is the theme of the Victorian Branch End of Year Breakfast, which will be held on Friday 25 November at the Melbourne Cricket Ground. Click here for more information and to book.

>> Professor Peter O’Sullivan APAM FACP is a John Curtin Distinguished Professor in the School of Allied Health at Curtin University and a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2017). Peter also consults at Body Logic Physiotherapy.