Worshiping the volcano god of pain

Pain In The Back? Exercise May Help You Learn Not To Feel It
January 13, 2014
http://www.npr.org/sections/health-shots/2014/01/13/255457090/pain-in-the-back-exercise-may-help-you-learn-not-to-feel-it

worshiping the volcano god of pain!’ And I thought: ‘What is this about?’ ”

Rainville explains: “In primitive cultures, if you lived near a volcano and the volcano started smoking and looking like something was going to happen, well, it was obvious[ly] because gods were mad at you. And you’d start doing silly things — sacrificing chickens or goats or whatever, thinking that that would appease the gods.”

In a strange way, Rainville says, people with chronic back pain do something very similar. They sacrifice parts of their life — playing golf or softball, running, picking up bags of groceries or grandchildren. Patients get so afraid of pain, they do anything to avoid it.

“They keep putting things onto this altar, thinking that’s going to change the situation,” Rainville says.

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Prevention of Low Back Pain

Prevention of Low Back Pain
A Systematic Review and Meta-analysis
JAMA Intern Med. 2016;176(2):199-208.
Daniel Steffens, et al.
http://archinte.jamanetwork.com/article.aspx?articleid=2481158

Conclusion and Relevance:  The current evidence suggests that exercise alone or in combination with education is effective for preventing LBP. Other interventions, including education alone, back belts, and shoe insoles, do not appear to prevent LBP. Whether education, training, or ergonomic adjustments prevent sick leave is uncertain because the quality of evidence is low.

journalistic version:
http://www.npr.org/sections/health-shots/2016/01/11/462366361/forget-the-gizmos-exercise-works-best-for-lower-back-pain

App to Self-Manage Low Back Pain

Principal Investigator: Blair Irvine, ORCAS (the company that sells the app)
Mobile-Web App to Self-Manage Low Back Pain: Randomized Controlled Trial

A Blair Irvine, et al.
J Med Internet Res 2015 (Jan 02); 17(1):e1
http://www.jmir.org/2015/1/e1

Background: Nonspecific low back pain (NLBP) is the diagnosis for individuals with back pain that has no underlying medical cause (eg, tumor, infection, fracture, herniated disc, spinal stenosis).
The American College of Physicians (ACP) and American Pain Society (APS) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks.
This approach, however, is impractical for many physicians to implement, and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines.

Objective: This study evaluated the efficacy of a mobile-Web intervention called “FitBack” to help users implement self-tailored strategies to manage and prevent NLBP occurrences
http://www.orcasinc.com/products/fitback

Methods: A total of 597 adults were recruited, screened, consented, and assessed online at baseline, at 2 months (T2), and at 4 months (T3). After baseline assessments, participants were randomized into three groups: FitBack intervention, alternative care group that received 8 emails urging participants to link to six Internet resources for NLBP, and control group. The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessments. The control group was only contacted to do assessments.
Results: Users of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical, behavioral, and worksite outcome measures at 4-month follow-up. In addition, users of the FitBack program performed better than the alternative care group on
current back pain, behavioral, and worksite outcomes at 4-month follow-up.
For example, subjects in the control group were 1.7 times more likely to
report current back pain than subjects in the FitBack group; subjects in the
alternative care group were 1.6 times more likely to report current back
pain at 4-month follow-up. Further, the users of the FitBack program showed
greater improvement compared to both the control and alternative care groups
at 4-month follow-up on patient activation, constructs of the Theory of
Planned Behavior, and attitudes toward pain. Conclusions: This research
demonstrated that a theoretically based stand-alone mobile-Web intervention
that tailors content to users’ preferences and interests can be an
effective tool in self-management of low back pain. When viewed from the
RE-AIM perspective (ie, reach, efficacy/effectiveness, adoption,
implementation fidelity, and maintenance), this study supports the notion
that there is considerable value in this type of intervention as a
potentially cost-effective tool that can reach large numbers of people. The
results are promising considering that the FitBack intervention was neither
supported by professional caregivers nor integrated within a health
promotion campaign, which might have provided additional support for
participants. Still, more research is needed on how self-guided mobile-Web
interventions will be used over time and to understand factors associated
with continuing user engagement. Clinical Trial: Clinicaltrials.gov
NCT01950091; http://clinicaltrials.gov/ct2/show/NCT01950091

Low Back Pain

Low Back Pain
Jan 24, 2014
http://www.evanshealthlab.com
Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael’s Hospital.

cited by:
http://www.npr.org/blogs/health/2014/07/20/328273003/a-youtube-video-is-doctors-secret-weapon-against-back-pain

Pain In The Back? Learn Not To Feel It

Pain In The Back? Exercise May Help You Learn Not To Feel It
January 13, 2014
http://www.npr.org/blogs/health/2014/01/13/255457090/pain-in-the-back-exercise-may-help-you-learn-not-to-feel-it

One reason invasive treatments for back pain have been rising in recent years, Deyo says, is the ready availability of MRI scans. These detailed, color-coded pictures that can show a cross-section of the spine are a technological tour de force. But they can be dangerously misleading.

“Seeing is believing,” Deyo says. “And gosh! We can actually see degenerated discs, we can see bulging discs. We can see all kinds of things that are alarming.”

That is, they look alarming. But they’re most likely not the cause of the pain.
Lots of people who are pain-free actually have terrible-looking MRIs.

Research is showing that the pain often has nothing to do with the mechanics of the spine, but with the way the nervous system is behaving, according to Dr. James Rainville of New England Baptist Hospital in Boston.

“It’s a change in the way the sensory system is processing information,” says Rainville, who is a physiatrist, or specialist in rehabilitation medicine. “Normal sensations of touch, sensations produced by movements, are translated by the nervous system into a pain message. That process is what drives people completely crazy who have back pain, because so many things produce discomfort.”

original articles:
Overtreating Chronic Back Pain: Time to Back Off?
J Am Board Fam Med January-February 2009, 22 (1): 62-68
Richard A. Deyo
http://www.jabfm.org/content/22/1/62.full.pdf+html

The Choosing Wisely campaign: back off on 45 diagnostic tests

Doctors Urge Their Colleagues To Quit Doing Worthless Tests
April 04, 2012
http://www.npr.org/blogs/health/2012/04/04/149978690/doctors-urge-their-colleagues-to-quit-doing-worthless-tests

Nine national medical groups are launching a campaign called Choosing Wisely http://www.choosingwisely.org to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays.
Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody’s about to undergo surgery.

And here’s one that raises some tricky questions: Most patients who are debilitated with advanced cancer shouldn’t get more chemotherapy.

Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.

“That’s certainly the number we use,” Dr. Steven Weinberger, CEO of the American College of Physicians, tells Shots. “Most of us feel something like $750 billion or so could be eliminated from the system out of the $2.5 trillion or so that we spend on health care.”

Weinberger says unneeded diagnostic tests probably account for $250 billion.

Proponents of the campaign are aware they’re wading into dangerous waters.
“There will be some … that may demonize this campaign and infer the R-word — rationing,” Daniel Wolfson of the ABIM Foundation wrote in December when the campaign was launched.

But rationing is the denial of care that patients need, Wolfson points out.
The Choosing Wisely campaign aims to reduce care that has no value.