David Pinnock, MSc, RN, DipHE, Clinical Nurse Specialist
Nottingham Back Team, Mobility Centre, City Hospital, Nottingham
Back pain is an extremely common symptom experienced by between 60 and 80% of people at some time in their lives (Papageorgiou et al, 1995). In most cases it is self-limiting, with approximately 46% of cases resolving within four weeks of onset (Mason, 1994). Most commonly it causes minimal interference with daily activities (Croft et al, 1996). However, for others, it is severely disabling (Croft et al, 1996) and impacts dramatically on their quality of life (Ruta et al, 1999).
In Nottingham a team was assembled to organise and deliver care to people referred to see a spinal surgeon who were very unlikely to be offered medical treatment for their back problem. The team comprises nurses, occupational therapists, physiotherapists, clinical psychologists, a project manager and team secretary.
This paper has discussed back pain and charted the growth of multidisciplinary teams using a biopsychosocial model to manage this condition.
Buckelew, S.P., Conway, R., Parker, J. et al. (1998) Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Research 11: 3, 196-209.
Cherkin, D.C., Deyo, R.A., Street, J.H. et al. (1996) Pitfalls of patient education: limited success of a programme for back pain in primary care. Spine 12: 3, 345-355.
Cherkin, D.C, Wheeler, K.J., Barlow, W., Deyo, R.A. (1998) Medication use for low back pain in primary care. Spine 23: 5, 607-614.
Clinical Standards Advisory Group. (1994) Report on Back Pain. London: The Stationery Office.
De Craen, A.J.M., Di Giulio, G., Lampe-Schoenmaeckers, A., Kessels, A.G.H. (1996) Analgesic efficacy and safety of paracetamol-codeine mixtures versus paracetamol. British Medical Journal 313: 321-325.
Croft, P.R., Papageorgiou, A.C., Ferry, S. et al. (1996) Psychologic distress and low back pain evidence from a prospective study in the general population. Spine 20: 24, 2731-2737.
Guzman, J., Esmail, R.K., Karjalainen, K. et al. (2001) Multidisciplinary rehabilitation for chronic low back pain: a systematic review. British Medical Journal 322: 1511-1516.
Henry, D., Lim, L.L., Rodriguez, L.A.G. et al. (1996) Variation in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta analysis. British Medical Journal 312: 1563-1566.
Karjalainen, K., Malmivaara, A., van Tulder, M. et al. (2001) Multidisciplinary biopsychosocial rehabilitation for subacute low back pain in working-age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 26: 262-269.
Kendall, N.A.S., Linton, S.J., Main, C.J. (1997) Guide to Assessing Psychosocial Yellow Flags in Acute Low Pack Pain. Wellington, New Zealand: Accident Rehabilitation and Compensation Insurance Corporation and National Advisory Committee on Health and Disability.
Little, P., Roberts, L., Blowers, H. et al. (2001) Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain. Spine 26: 19, 2065-2072.
McQuay, H.J., Moore, R.A., Eccleston, C. et al. (1997) Systematic review of outpatient services for chronic pain control. Health Technology Assessment 1: 6.
Mannion, A.F., Muntener, M., Taimela, S., Dvorak, J. (1999) A randomised clinical trial of three active therapies for chronic low back pain. Spine 24: 23, 2435-2448.
Mason, V. (1994) The Prevalence of Back Pain in Great Britain. London: OPCS Social Surveys Division/The Stationery Office.
Papageorgiou, A.C., Croft, P.R., Ferry, S. et al. (1995) Estimating the prevalence of back pain in the general population. Spine 20: 1888-1894.
Ruta, D.A., Garrett, A.M., Russell, I.T. (1999) Patient centered assessment of quality of life for four common conditions. Quality in Health Care 8: 22-29.
Savage, R.A., Whitehouse, G.H., Roberts, N. (1997) The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. European Spine Journal 6: 2, 106-114.
van Tulder, M.W., Koes, B.W., Bouter, L.M. (1997) Conservative treatment of acute and chronic non-specific low back pain: a systematic review of randomised controlled trials of the most common interventions. Spine 22: 18, 2128-2156.
van Tulder, M., Malmivaara, A., Esmail, R., Koes, B. (2000) Exercise therapy for low back pain: a systematic review within the framework of the Cochrane Collaboration back review group. Spine 25: 2784-2796.
van Tulder, M.W., Ostelo, R., Vlaeyen, J.W. et al. (2001) Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine 26: 270-281.
Waddell, G. (1998) The Back Pain Revolution. London: Churchill Livingstone.