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Low back pain is the most common symptom seen in primary care; the underlining injury is often enhanced by psychological and social stressors, write the authors of a published online today by the Medical Journal of Australia.
Associate Professors Leigh Atkinson, from Wesley Pain and Spine Centre in Brisbane, and Andrew Zacest from Royal Adelaide 黑料吃瓜群网 wrote that patients often have high expectations from modern medicine and expect a surgical solution to their back pain.
They explained the high incidence of low back pain in developed countries is best understood in terms of a biopsychosocial framework, in which the pain from an injury is compounded by issues such as work dissatisfaction, family stress, depression and at times secondary gain.
Often compensation system and third party insurance prolongs rehabilitation and extends recovery. However, a study of patients receiving workers鈥� compensation in New South Wales found surgery outcomes were so poor that the benefits were marginal.
鈥淭he incidence of persistent post-operative pain syndrome was as high as 40% and 鈥� there was a 50% success rate, at best, from the first operation, 30% from the second and 15% from the third,鈥� the authors explained.
The authors noted a growing tendency for spinal surgeons 鈥渢o have all patients assessed independently and, at times, for them to attend an interdisciplinary pain program to clarify issues of psychological and social origin鈥�.
They also observed that the increased sedentary lives of Australia鈥檚 ageing population has further compounded the problem.
鈥淲hile the spinal fusion procedure remains controversial, it would be valuable for spinal surgeons to undertake a national audit of patient-centred outcomes for the procedure, similar to the excellent audit carried out for hip and knee arthroplasties by the Australian orthopaedic surgeons,鈥� they concluded.
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