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 2nd of 5.
The broader view
Several presentations recognised that it’s not just about back pain, but rather overall health. Rachelle Buchbinder (Cabrini Institute, Australia) quoted the WHO definition of “health” from 1948, which points out that health is more than just the absence of disease.
“There is a need to look broader across diseases, rather than just treating them in isolation”. Those were the policy and practice implications of a study presented by Dian Kuh (University College London, UK). Peter Croft’s (Keele University, UK) presentation also touched on this by recognising that the average chronic back pain sufferer experiences co-occurrence of two or more chronic medical conditions (referred to as “multi-morbidity” in research circles). Peter referred to a 2010 study published in the New England Journal of Medicine by Katon et al. The study concluded that depression, disease and general health outcomes all improve when a collaborative care approach for multiple chronic diseases is applied.
Back pain. A manifestation of poor health
Back pain is a symptom of poor health. Yet the outcome of one study presented by Amabile Borges Dario (University of Sydney, Australia) “proved” that being overweight does not directly contribute to back pain. So, no correlation between obesity and back pain. While this may technically be true, it is possibly also irrelevant. Most reasonable people would agree that being overweight does contribute to poor health. If back pain is a manifestation of poor health, then being overweight is also a contributing factor to back pain, though an indirect one. As a back pain sufferer, the academic question of whether being overweight is a direct or indirect contributor to back pain is irrelevant. Bottom line is that being overweight does not help!
Christopher Williams (University of Newcastle, Australia) recognised the complexity of back pain. He advocates “system thinking” and a move away from thinking in terms of “one off solutions”. Connections between lower back pain and other conditions/risks, such as obesity and smoking, often go unnoticed. Care needs to be integrated, rather than isolated the way it is today. His study revealed that patients themselves are interested in addressing wider issues of poor health. Not just back pain in isolation. In short, interventions should be about fixing somebody’s health, not just their back.
I posed the question whether there are limitations of how far health services can go with this system thinking approach, give resource constraints. Christopher responded that while there is a role for the private sector to get involved, this needs to be driven by the public sector. Overall cost savings available to the public sector through system thinking are substantial. Others in the audience challenged the “system thinking” approach with respect to implementation difficulties, health economics and the extent to which clinicians are equipped to deliver health services in this way.
This appears to be radical new thinking in research, i.e. looking at “the system”. Most studies presented at the Forum looked at bits and pieces, sometimes relevant and insightful – sometimes not.
Let’s collaborate more…
More “radical new thinking” surfaced during the final Round Table discussion, where Rob Smeets (Maastricht University, Netherlands) highlighted the importance of thinking outside established paradigms and learn from other fields.
Raymond Ostelo (National Institute for Public Health and the Environment, Netherlands) took this one step further and suggested the Back Pain Forum be opened up to experts in other fields, such as computer scientists and surgeons. In my view more cross functional working both on the research and pain management side would be beneficial to patients.
… and embrace eHealth
One of the more innovative studies, presented by Hopin Lee (Neuroscience Research Australia), focused on using social media as a way of delivering eHealth. 72% of internet users already search for health related topics. The potential of eHealth was illustrated with the example of Google Flue Trends, which was able to detect flue trends 2 weeks earlier than traditional methods. While eHealth could be used for delivering targeted health advice, there are risks as well as advantages associated with this approach.