When Your Back Goes Out More Than You Do
It is associated with many factors that vary from person to person but can be caused by an injury, a disc or joint problem, an irritated nerve root or poor posture. The pain might be acute or chronic but living with either can be debilitating.
Pain is considered chronic if it lasts more than three months and exceeds the body’s natural healing process. Either way, failing to get pain relief after different treatments is very frustrating. It can lead to depression, loss of working hours, extensive treatments and often sufferers lose hope and resort to popping painkillers or going for surgery. Both of which can be counterproductive.
Surgery not the only option
Many people assume that surgery is their only option to treat severe back pain. However, according to Dr Jacques Gilau, clinical head for Dr JJ Gilau and Partners utilising Documentation Based Care (DBC) technology in South Africa, ‘only a small percentage of people with back pain require surgery.’ DBC uses effective methods of physiotherapy and musculoskeletal rehabilitation for back and neck pain. Usually a 6-week interdisciplinary programme that includes treatment by doctors, physiotherapists and biokineticists.
The programme was developed for chronic pain relief by a group of Finnish experts in 1993 and begins with an in-depth assessment followed by a treatment regime that incorporates active exercise with appropriate weights and motion. These target the trunk and neck muscles of the spine to help restore mobility and control. Patients are monitored regularly to determine progress and relaxation is an essential part too, as is guidance on how to use the spine to lead a normal life.
Bonitas Medical Fund has partnered with DBC so that its members have access to a back and neck programme of up to six weeks, to either prevent surgery or, when it is unavoidable, prepare and strengthen ahead of surgery and rehabilitation afterwards.
Gerhard Van Emmenis, Principal Officer of Bonitas, says, ‘We believe in the preventative management of chronic back and neck pain and since partnering with DBC have had excellent feedback. Members are staying active, developing a better understanding about their pain, identifying the factors involved in their pain and living regular lives.’ According to the DBC statistics the success rate for treating chronic back and neck pain to avoid surgery is 91% at two years follow-up and 75% at five years follow-up evaluation (results from a study done in 2005-2007 and published in SAOJ Vol 7 No 2, Autumn edition.)
The outcomes include restoring the range of motion in your back and neck as well as muscle co-ordination and movement control, and an improvement in muscle endurance and strength. ‘Part of the programme also looks at re-education around pain management to reduce fear and avoidance behaviour associated with pain,’ explains Van Emmenis. ‘DBC tackles psychosocial obstacles and encourages continued activity. After the treatment a home-based programme is put in place, which is monitored by an attending doctor, to maintain long term results.’
Pre- and post-surgical therapy
When upon diagnosis, ‘red flags’ (specific risk factors indicating the need for immediate surgical intervention) have been excluded; a patient should ideally be seen by a DBC doctor who will assess whether they are suitable for inclusion on the programme.
In about 70% of cases the patient will be able to avoid surgery in the short to medium term. ‘However, when the pathology is too far gone,’ explains Dr Gilau, ‘we will still attempt a “prehab” protocol (if risks, pain and discomfort allow) in order to afford the patient the best opportunity of a quicker and safer post-op recovery.’ This includes:
- Abdominal and deep postural muscles stabilisation techniques which are best learned before being immobilised in an ICU/Highcare bed under partial sedation for pain.
- An opportunity for patients to ask the doctor questions during this pre-op therapy which they often forget to ask their surgeon because of stress or time constraints. This includes information about the planned surgery and 3-6 month post-op period.
What benefits does the DBC programme have in terms of healing and recovery time?
Biopsychosocially, the benefits are threefold:
- Physically (bio): Physical gains relating to all spinal muscles, ligaments, connective tissues and especially improving microcirculation to discs and facet joints. This usually means a patient can be weaned out of the back brace sooner and more easily than when a patient is unprepared for surgery.
- Psychologically (psycho): The patient feels more in charge of the problem and takes better ownership which creates a better outcome. They are better prepared to cope with unexpected setbacks thereby avoiding catastrophising fear and anxiety issues and post-traumatic stress and depression.
- Socially: The family members and employer are also better informed as to risks and possible obstacles to returning to normal life and work capabilities.
Can surgery be avoided?
According to Dr Gilau surgery can often be avoided. ‘However’, he says, ‘for cases where the physical/biological indication for surgery is the same, it usually comes down to the patients’ mindset, mental and emotional resilience and pain tolerance, when the final decision to operate is made. Patients with a strong internal locus of control are observed to cope better and are less likely to ultimately require surgical intervention.’
Spine surgery should not be regarded as a quick fix solution especially where the reason for surgery is ill-defined and pain is biomechanical in nature. Surgery is usually NOT the end of the problem or process, but merely the start of a new set of challenges faced by the patient.
Healthcare workers cannot/should not create the impression of a permanent fix of the particular problem but rather promise a long-term management plan for the expected pain flare-ups – much the same as for managing Diabetes or Asthma.
Van Emmenis says, ‘Bonitas members can go directly to the DBC Centre and enrol in the patient program, no pre-authorisation is required before the treatment begins. Although the programme is usually 6-weeks the length depends on the severity of the back pain and the patient requirements. Bonitas covers the cost of the DBC treatment on all plans, except BonCap.’