Back pain is a global menace. It is the biggest cause of disability worldwide; it affects whole economies, individuals’ health and makes lives a misery. Back pain contributes to obesity, diabetes, osteoarthritis and mental health issues as those with back pain cannot exercise as much as they would wish. The 2020s should see major advances in back care.

Despite not getting the attention or funding that conditions like Alzheimers and cancer receive, there are exciting developments in treatment, policy and back research which will change how we approach back pain over the next decade.

1. Artificial discs 

Once a thing of science fiction, man-made discs are looking like a reality. As we get older the discs of the spine wear and although this is mostly painless, in some people it can cause extensive osteoarthritis, nerve or spinal cord entrapment and pain. Not nice!

The standard treatment, if people are beyond chiropractic care, is an operation to remove the old disc and then the adjacent vertebrae are fused together. It doesn’t have a great success rate and complications are high not least of all by accelerating the wear on the other discs in the area.

Primitive artificial discs and cages have been tried surgically but don’t have the strength and mobility that a healthy spine requires. The latest innovation is to inject stem cells into an artificial polymer gel matrix in the lab and top and tail it with foam – mimicking a real disc. These discs have been transplanted into goats successfully and initial reports are that they perform as well as normal discs. You can watch the video – click here.

Whilst the researchers have yet to carry this out in humans it is a huge step in the right direction.

2. Stopping ineffective and dangerous drugs to treat back pain

A class of painkilling drug is increasingly being prescribed, including for back pain despite being ineffective for this sort of pain and is so dangerous that it can kill. In the USA, where the problem is much worse, more than 70,000 people a year are dying from a prescribed opioid class drug. In recent years Tom Petty and Prince died from these legal drugs which are often many times more powerful than heroin. In the UK, figures are harder to come by but in 2018 one drug alone, tramadol, was implicated in 220 deaths. There are many others which go by names such as dihydrocodeine, codeine, oxycodone and morphine. 

Doctors are often pressured by patients to prescribe more powerful painkillers when the standard drug treatment of anti-inflammatory medication, such as ibuprofen, is not effective. Most doctors are well aware of the problem so if you have been prescribed these drugs or are taking them without a prescription then talk to your GP.

The chiropractic profession, particularly in the US and Canada, has been proactive in raising awareness of this problem. Research has shown that opioid use is much lower amongst back sufferers who go to a chiropractor than those who go to medical doctors alone. People who saw a chiropractor were 64% less likely to use opioids than people who didn’t, researchers report in the journal Pain Medicine.

As the problem becomes more widely recognised, the next decade should see a steady reduction in opioid prescriptions for back pain and the devastating harm associated with them.

3. Chiropractors on the NHS

Physiotherapy in the NHS is not keeping pace with the levels of back pain. Waiting times are huge in some areas, and when you do finally get to see a physio’ you are often given a sheet of exercises and told to go home and do them. Part of this is due to funding but it is also due to the fact that most NHS physiotherapists are not back experts and most doctors are not back specialists either.

The incidence of back pain is likely to rise over the next decade, in line with the ageing population. If the latest government promises are to be believed, then funding on the NHS should rise. But spending more on services where the skills are poor is not going to be the solution. 

In a handful of locations around the UK chiropractors and osteopaths are employed by the NHS in a variety of diagnosis and treatment roles, often as first contact practitioners. Such a system also works in the USA, Canada, Switzerland and Denmark. If the NHS is going to improve back care then it will have to look at existing expertise and use chiropractors and others embedded in hospitals, GP surgeries and in community practices, many of which are up and running already. This sort of approach exists already with NHS and private dentists and podiatrists (thank goodness they changed their name from chiropodists!).

4. Back sufferers finally given a diagnosis

If you go to a doctor with a pain in your back, if you don’t have any serious disease or injury, you are most likely to be told that you have non-specific back pain. What this means is that they don’t know which bit of you back is causing the pain and are just going to treat the pain, not the cause. This is a non-diagnosis.

As chiropractors become more common within the NHS patients should be told what the cause of their back pain is likely to be. Differentiating a muscle spasm from sciatica, a disc problem from a pelvic problem is straightforward if you have the training and experience to do so. This improves access to the right treatment and helps people get better faster.

Chiropractors have these diagnostic skills and have been shown in study after study to provide effective back pain treatment. Access to MRI and other imaging techniques directly for the few who need them will speed up diagnosis and free up the GPs to do what they do best – treating things other than back pain. 

5. Ending these dangerous exercises

Deadlifts, touching toes and leg press exercises are amongst the drills that will be recognised by the fitness industry as contributing to back pain and will be phased out. Currently, there is a mismatch between most, but not all, spine care experts and gym and yoga instructors. As more up to date research makes its way to the courses for these professions practise will change and fewer back injuries will result.

I hope that these predictions are more than my benign, post-Christmas fug and that they will come to pass. They are all feasible but some are more likely than others. All will improve the lives of the thousands suffering from back pain. 

Matthew Bennett

Sundial Clinic Principal

Opioid references:

https://www.physiciansweekly.com/chiropractic-care-for-back/

https://www.independent.co.uk/voices/opioid-crisis-addiction-drugs-prescription

https://fpm.ac.uk/opioids-aware-clinical-use-opioids/current-uk-data-opioid-misuse