The International Forum for Back & Neck Pain Research is an event that takes place approximately every 18 months in different parts of the world. It’s an opportunity for researchers and practitioners to get together from across the globe to talk all things back and neck pain. The event takes place over 4 days and is centred around research presentations, poster exhibitions and workshops. This year I (Armand Brevig) attended the 14th Forum in Buxton UK to see what I could learn about advances in back pain research and management. The venue was the historic and impressive Devonshire Dome. The Forum provided fascinating insights into the thinking and approaches of researchers and practitioners in this field. I will share my thoughts with you on what I heard in 5 brief themed articles. Unless otherwise stated, all opinions are my own. This article is the 1st of 5.
I was just wondering…
Three questions arose in my mind during the Forum:
- What’s the point of some of these studies? Are the right research questions being asked?
- Are quantitative studies the right way to go?
- If the purpose is to beat back pain, why not study those patients that have actually recovered?
So, what’s the point?
Lots of back pain research presented was both valuable and insightful. However, in my opinion, some of the research came across as fragmented, disjointed and of questionable practical relevance. During the final Round Table discussion, Rob Smeets (Maastricht University, Netherlands) said that going forward it is important to consider what research is really necessary. This will ensure finite resources are used in the best way possible.
The Round Table session continued to discuss what the focus of future research should be. Rob felt it should be disability, rather than pain itself. Jan Sture Skouen (University of Bergen/Haukeland University Hospital, Norway) felt the focus should specifically be on getting people back to work. Raymond Ostelo (National Institute for Public Health and the Environment, Netherlands) questioned whether scientists should come up with research questions. Perhaps clinicians are best placed to pose the questions.
The problem with quantitative studies
Detail and insight at the individual level are lost when quantitative data is collected and analysed for a larger population. For example, at the study level the mechanism for improvements in back pain sufferers is often unknown. However, an individual may very well know his/her precise diagnosis and what steps made him/her better and why. This mechanism will vary from individual to individual depending on their issues. A quantitative study looking across a larger population cannot easily capture that level of granular case by case insight.
Learn from those that got better, rather than those that got worse
Many in the research community believe that becoming totally pain free is not realistic for most. They think that focusing on teaching people to live with the pain is the right focus. Studies have, therefore, been done on people who were able to cope with the pain (Haitze de Vries, University
of Groningen, Netherlands, et al), but possibly none on people who have made a full recovery from chronic back pain.
I respectfully disagree that becoming pain free is not within reach for most. Because back pain is very individual with different causes and contributing factors, standard solutions are ineffective. Back pain does not respect the boundaries of the field of any one particular therapist or medical professional. No single expert has all the answers.
That’s why recovery requires a precise diagnosis and safe experimentation at the patient level. See the article How to discover your own back pain solutions and claim your life back! Even someone who has been in pain for 18 years can become totally pain free once he discover the right mix of interventions. Read Jason’s story.
During a workshop called “Better research or better ideas” there was recognition that there is a lot to learn from those that recovered from back pain.
Qualitative back pain research on a population that has recovered from chronic pain, possibly followed up by quantitative back pain research, is much more likely to yield actionable insights. Study those that have been fixed (or fixed themselves) and not just those that remain “broken”. This approach has already been successfully tried in the field of psychology. Focus was on pathology until relatively recently when the field of “positive psychology” emerged.