06/29/2023
Some excellent quotes from Professor Peter O’Sullivan, PhD- one of the world's leading pain researchers.
-“Depressed mood predicts future episodes of pain better than abnormal findings on an MRI film.”
-“However, when patients are told that the treatment technique ‘puts the pelvis back in’, this can reinforce fear of movement, avoidance behaviours, a loss of confidence in their body and hyper vigilance.These factors can reinforce chronicity. Many patients demonstrate this by statements such as ‘I can’t go for a walk because it will put my pelvis out of place’ or ‘I can’t lift my baby because I have an unstable pelvis and it will cause more damage’. These non-evidence-based beliefs are generally transferred to patients by well-meaning healthcare practitioners; however, they risk leaving patients fearful, avoidant and reliant on passive treatments, or developing muscle-guarding strategies and reliance on pelvic belts in a vain attempt to control their pain.”
-“There is a high prevalence of ‘abnormal’ findings on MRI in pain-free populations: disc degeneration (91%), disc bulges (56%), disc protrusion (32%), annular tears (38%).”
-“In short, all relevant studies find no difference in pelvic movement or bony alignment between painful and non-painful sides in people with chronic low back or pelvic pain. Many people will of course feel better after undergoing manual therapy of various kinds. However, this improvement is due to reductions in pain, muscle tone and fear rather than realigning of body structures. Unfortunately, being told that you have something out of place can lead to fears about the structural integrity of the body, and increase dependence on others for help. Instead, best practice for such pain disorders should involve a multidimensional approach using a range of physical, lifestyle, cognitive and coping strategies.”
-“Negative back pain beliefs and fear of pain and movement are more predictive of disability levels, than levels of pain intensity.”
-“Working the core” has become a huge focus of rehabilitation of athletes and non athletes in recent years. The belief that the spines stabilising muscles become inhibited with back pain rendering the spine ‘unstable’ and ‘vulnerable’ drives this. Yet growing evidence tells us that disabling persistent back pain disorders are often associated with increased trunk muscle co-contraction, earlier activation of the transverse abdominal wall and an inability to relax the spines stabilising muscles such as lumbar multifidus”
-“The biomedical approach to managing persistent back pain over the past 15 years has led to a marked increase in: exercise therapies directed to increasing the ‘stability’ of the spine; MRI imaging; spinal injections; surgical interventions and opioid analgesics use; and health care costs. Ironically, there has been a concurrent increase in disability relating to back pain.”
-“This is maintained by the underlying belief that LBP is fundamentally a patho-anatomical disorder and should be treated within a biomedical model. This is in spite of calls over a number of years to adopt a bio-psycho-social approach, and evidence that only 8–15% of patients with LBP have an identified patho-anatomical diagnosis, resulting in the majority being diagnosed as having non-specific LBP.”
-“Early MRI imaging for low back pain can result in poorer health outcomes.”
-“Radiological imaging for LBP, in the absence of red flags, progressive neurological deficits and traumatic injury, is not warranted and may in fact be detrimental. However, over-imaging for LBP is endemic in primary care. Although advanced disc degeneration, spondylolisthesis and modic changes of the vertebral end plate (changes to the bone structure of the vertebral body that may be seen on MRI) are associated with an increased risk of LBP, they do not predict future LBP”
-“In disc prolapse, the natural history is good; the majority of cases recover and the prolapse reduces in size over time. Long term outcomes for surgical intervention are no different to usual care”
