Non-specific back pain

90% of back problems fall into the category of non-specific pain pain
23% of the population suffer chronic back pain 

what is non-specific back pain?

This is a good question since most people in ‘backworld’, both clinicians and scientists, are asking the same question. Non-specific back pain also goes by the name of ‘simple back pain’ or ‘back pain of unknown aetiology’. It is a burning question, for the reason that between 90-95% of cases of back pain fall into this category. ‘Unknown aetiology’ means we don’t know the cause.

You might well find this baffling in a day and age when - a rather old cliche by now – we can land men on the moon yet we can’t find the cause of this cripplingly common, earthbound complaint. And furthermore, we’ve made so little progress in finding the cause. With the oceans of people worldwide getting around in varying degrees of distress from back pain – or buttock, or leg, or chest, or shoulder, or neck – we have to fess up that it’s all a bit inadequate. 

You might like to listen to this recent Radio National (Australia) Health Report summary of the general therapeutic status quo with backs, although it initially focuses on the poor results from cortisone injections for sciatica.

As a lone voice – some would say, a rather foolhardy lone voice – it could be seen as borderline ludicrous to be expressing a view at all. Especially when there are so many people so much cleverer than I, wrapping their minds around the very same problem. Nevertheless, I take the view that with 40 years of clinical experience and too many patients under my hands to count, I might express a view.

I hope that my recent 2-part paper co-written with Professor Mike Adams from Bristol University (the most cited spinal researcher in the world today) and physiotherapist Manos Stefanakis PhD Healing of Painful Intervertebral Discs: Implications for Physiotherapy proves interesting reading.

For Part 2 Pressure Change Therapy - a proposed clinical model to stimulate disc healing. 

I also believe that with surgical options always looming large as the rightful solution to back problems, the diagnostic world has become too fixated on finding nuts and bolts reasons for pain; for finding evidence of something demonstrably wrong on the scans or images (MRIs, CTs and X-Rays) when it might have nothing to do with it. I first expressed this view more than a decade ago in the first edition of my book The Back Sufferers’ Bible.

To quote myself from the same book today, I say:

I believe the medical profession has focused ‘too deep and too narrow’ on backs, looking for cold hard evidence of anomalous spinal structures—enlarged or broken, say—instead of searching and listening in a more subtle way for function faults which may be reversible. Looking only for the whizz-bang stuff can shift the emphasis so far awry that evidence unable to be found presents another quandary: the sufferer who is disbelieved or, worse still, dismissed as malingering or making a fuss.

The facts of the matter are this: The outer part of the disc is different to the inner bits because it has a nerve supply. The outer part is different in another way too: it works like a ligament and thereby holds the vertebrae together. By contrast, the inner disc and nucleus works like a pressurized bag that springs the vertebrae apart. The inner and outer parts of the disc work to complement each other, like air in a car tyre keeping the outer wall tense.

The few outer ligamentous layers of the disc wall is where all the
pain-action happens

The important point is that ligaments restrain s-t-r-e-t-c-h and in doing so, ligaments are easily hurt. Think how easy it is to strain an ankle. Well, with 24 moving segments of a spine, it’s far easier to strain a vertebral ligamentous link. Once the segment has been hurt (as I’ve said, you can do it turning over in bed) a chain reaction starts off as muscles tighten and other, less-reversible changes happen to the other soft tissues nearby. Before long, you get your stiff and painful spinal segment – and your back pain.

I believe this is the typical genesis your common-or-garden non-specific back pain or ‘simple’ back pain. You can read more about this widespread complaint on my other website www.simplebackpain.com under the section Spine Disorders

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