In fact, low back pain affects 1 in 4 adults, of whom 10%-15% go on to develop chronic pain, defined as lasting more than 3 months. For 85% of those individuals, there is no specific cause and no reliably effective treatment. Professional guidelines advise against the use of imaging studies, narcotics, or surgery in these patients, yet rates of all three have increased dramatically in the last decade.
“Chronic opioid use is not a good answer for most people. They have huge side effects, they only work for a short time, give limited symptom relief but do not really get you functioning again,” NCCAM director Dr. Josephine Briggs told me. And there are no good guidelines as to which patients should be sent for imaging, or when. “There is a general feeling that these methods are overused, that they don’t necessarily yield an outcome that helps in management.”
For nonspecific chronic back pain, the guidelines suggest certain non-drug therapies, including exercise, spinal manipulation, acupuncture, yoga, and massage, which have shown at least some benefit. But the evidence base for alternative treatments is far from comprehensive.
And importantly, there is nothing available that will help prevent a patient with acute pain from going on to develop chronic pain. Most acute back pain resolves within 6 weeks, but how does the clinician identify the patients who will progress without more intensive intervention? Some workshop participants suggested a Framingham-like longitudinal study to look at that question.
The 22 panelists, tasked with advising NCCAM on back pain research priorities, also discussed the need for a better definition of chronic back pain that might include severity and function as well as duration, and the need for standardized outcome measures in back pain studies.
Given the heterogenous nature of back pain, its enormous associated health care costs, and the failure of conventional medicine to address it, the NCCAM—along with other branches of the National Institutes of Health—have deemed it a major research priority.
According to Dr. Briggs, “The gaps are huge. Back pain is a really tough problem. It’s an area for which we here at the NIH realize that we need to help doctors and patients. We need more science because our current strategies are just not working as well as we wish they would.”