Goal of the Study?
Non-specific low back pain (NSLBP) has been misunderstood by many. In this opinion paper1 published in The Spine Journal, the authors tackle an essential topic to help clarify that NSLBP does not mean non-specific treatments. They discuss the term’s history and how widespread utilization has hampered the research front in sub-classifying low back pain.
Why are they doing this study?
The diagnosis of NSLBP does not help the clinician investigating a low back pain patient, nor does it help the unhappy back pain sufferer. In 1956, Shaw and Taylor introduced the term NSLBP to identify the person’s clinical diagnosis if a nociceptive tissue could discern nothing after completing all the assessments. In other words, if all tests were negative, including lab tests and imaging, the person could be labelled as having a non-specific cause. Over the years, this term has been widely used and has yielded the idea that if there is no known cause and there must not be a specific treatment for the low back pain patient. Misunderstandings have developed, which has diminished the research drive to investigate spinal sources of back pain.
Over the years, there have been reasonable attempts to sub-classify back pain, with leaders in the field continuing to argue in the push to specify treatment for low back pain. For example, in 1981, Robin McKenzie introduced a classification system to individualize therapy for LBP. Others, like Waddell in 1987, proposed a biopsychosocial model considering the psycho and social influencers of low back pain who thought non-specific low back pain was intellectually and scientifically inadequate for understanding a biological source.
Currently, there is a lacking of precise clinical tests to help us identify a nociception source of low back pain. However, systems like the McGill Method have been developed that look at each case specifically with a thorough assessment to help match the appropriate treatment strategy(s)—including the psychological and social contributors.
Why does this opinion paper matter?
The term ‘non-specific’ has impeded our research efforts in the pursuit of finding treatment approaches to associate nociception with low back pain sources. In addition, the lack of robust research to target pathoanatomical sources has almost ‘given up’ because of the complexity of conducting such research. Most treatment approaches have resorted to keeping people ‘active’ without much advice on load management and dose of activity based on a person’s low back pain state. Admitting that the term non-specific does not help in specifying care is the first step in turning the research tides. The writers of this opinion piece believe that identifying pathoanatomical causes of low back pain should be part of the balanced approach to LBP research.
At Dynamic Disc Designs, we create dynamic human spine models showing a variety of low back pain conditions to help the clinician explain the probable sources of low back pain pathoanatomy. When patients can see and understand their likely sources, motivation and optimism about what to do usually enthusiastically surfaces.