Saturday, June 12, 2010

Chronic Back Pain - Is Deconditioning a Cause??

Doctors and scientists, all over the world, are still struggling with this question. And more generally, struggling to find a cause or causes of chronic pain.

Scientists are still trying to find out why some injuries go on to produce long-term or chronic pain, while many are resolved with time and treatment. In general, 10-20% of low back, neck, head, knee and shoulder injuries become chronic, even under the best and most comprehensive of treatment programs.

There are many theories attempting to explain this pattern. Thousands of studies have compared people whose injuries become chronic, with those whose injuries and pain heal within a short time. This approach, although the most common, can produce confusing results.

A recent Topical Review, in the journal Pain, focused on the possible role of deconditioning, or lack of physical fitness. The article, Cause or Effect? Deconditioning and chronic low back pain (Pain, 2010, 149, 428-430), was written by Verbunt, Smeets and Wittink, all from The Netherlands.

Here, the authors reviewed the evidence for the view that deconditioning is a cause of chronic low back pain. This view is prevalent among health care professionals that regularly treat patients with various types of chronic pain.

Interestingly, this review found "...minimal research evidence that patients with chronic low back pain suffer from disuse and physical deconditioning, before or after the onset of acute or chronic low back pain (page 430)".

This conclusion will shock many clinicians. It seems so obvious that deconditioning must play a role. Often, people in pain can do very little exercise, especially exercise that would lead to good conditioning.

The take home message here, is not that physical conditioning is not important. It is a necessary component of any treatment program. It is necessary, not just for the treatment of any type of chronic pain, but for almost all health care problems.

I am a keen supporter of exercise. I am an avid hockey player and ski and run whenever I can. All of the people in pain that I know, would love to be able to be more active. I know that, if they could, they would.

Yours with care


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