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Recent advances in the treatment of low back pain

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Summary

There is at the present time an epidemic of low back pain in the industrialized countries. Although the exact origin of such pain is still unknown, there is increasing awareness that the outcome is usually favourable. Only some 10% of those suffering an acute episode of back pain are incapacitated for more than 6 weeks. The causes of long standing back pain are being identified in an increasing number of patients. They include anatomical and pathological disturbances in the motion segment as well as psychological, social and political causes. There are numerous factors which influence the pathophysiology of the motion segment. The degree of loading has been successfully measured and delineated for various postures and exercises, including those at work. The nutritional pathways to the disc have been established and the effect of various external factors measured. Movement is good for the disc and the importance of continuous passive motion for the healing of diseased or injured connective tissues is now established. Activation of large muscle groups increases the production of the body's pain reducing encephalins. Early diagnosis and early mobilisation of the patient should be of benefit, and long term bed rest and inactivity must be prevented. Fewer cases will need operation in the future. Improved imaging techniques and better methods of operation and fixation will help those few who have a definite pathological lesion amenable to surgery.

Résumé

Il y a actuellement une véritable épidémie de lombalgies dans les pays industrialisés. Bien que l'origine exacte de ces douleurs demeure inconnue, il apparaît de plus en plus que le pronostic en est habituellement favorable. Dix pour cent seulement de ceux qui présentent un épisode lombalgique aigu ont une incapacité supérieure à 6 semaines. Les causes des lombalgies prolongées sont maintenant retrouvées dans un nombre croissant de cas. Elles englobent aussi bien des lésions anatomiques et pathologiques du segment mobile du rachis que des éléments psychologiques, sociaux et politiques. De nombreux facteurs sont en cause dans la physiopathologie de ce segment mobile. L'importance de la charge a été mesurée pour des positions et des mouvements divers, y compris ceux nécessités par le travail. Le mode de nutrition du disque a été précisé et l'effet de différents facteurs extérieurs a été mesuré. Les mouvements jouent un rôle favorable pour le disque et l'importance de la mobilisation passive continue dans la cicatrisation du tissu conjonctif malade ou traumatisé est maintenant bien établie. La mise en activité de groupes musculaires importants augmente la production d'encéphalines analgésiantes. Un diagnostic et une mobilisation précoces du malade sont bénéfiques, aussi le repos prolongé au lit et l'inactivité doivent-ils être évités. Dans l'avenir un petit nombre de cas nécessiteront un traitement chirurgical. Des techniques améliorées et de meilleures méthodes d'opération et de fixation aideront ceux chez qui une lésion pathologique définie justifie une intervention.

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  1. Department of Orthopaedic Surgery, Sahlgren Hospital, S-41345, Göteborg, Sweden

    A. Nachemson

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Current trends lecture SICOT 1984

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Nachemson, A. Recent advances in the treatment of low back pain. International Orthopaedics 9, 1–10 (1985). https://doi.org/10.1007/BF00267031

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