After reading this forum and numerous research articles day in day out now for years I have come to a simple deduction about longterm outcome measures in the treatment of Low Back Pain (and maybe other pains as well).

If we look at all the research it is clear to say that back pain is a normal condition. It appears at some time or another in most of us during working age. The jobs has little to do with it as it happens in workers, tribal communities and non-workers alike with little to no relationship to the "work" being performed. Psychosocial factors, moral, homelife etc does however show much more statistic relevance.

Alophysio recently noted when commenting on a knife wound that you could take a pain killer and, when that wore off, take another. Eventually the body heals underneath and you don't need to take the pain killer anymore. The point is the pain killer did not cure the problem. The body did. What the pain killer did was resolve you symptoms quickly and effectively letting you get on with it.

So what of longterm outcomes? The body for the most part heals itself. So won't most groups placebo or not be the same the longer we follw them up? The answer for the most part is YES.

Physiotherapy is good at making a difference now! when the problem is there! to ease the suffering and return the person to as a normal a life as possible as quickly as possible. Why then are we not looking at research into which gives more relief more quickly and leaving it as that. Returning a person to work quickly is more important than leaving them for 12 months to "self heal" from within. Now this is the nice thing as there is a direct cost implication for the economy. Of course we never make savings in the health care dollar because as one person comes off the list another one is always there to take their place. So we will never reduce the demand for healthcare, we will just increase the throughput. And because the populations is growing this is exactly what we need to do to manage the ever increasing waiting lists.

I beg all physios to question the relevence of any collegues research project for low back pain that bothers to look at anything post about 6 months. 1 and 2 year follow ups are a waste of time as the nature of low back pain is that it is recurring. What we do is increase the time between episodes and reduce the time the person suffers during the episode.

Any and all comments welcome 8o

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