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It's better to be non-specific

back pain back pain education Nov 05, 2021
missing the target

Everyone wants a specific answer to everything nowadays, including having answers that explain conditions such as back pain.

If you have seen a doctor or specialist about your back pain, you may have heard or read the phrase "non-specific low back pain". 

You might have been surprised by it or felt that you were being brushed off. If you haven't heard it before, you might be confused by it.

 

The good news

If you have "non-specific" back pain, it means that your back pain can not be attributed to a specific condition. You might roll your eyes, thinking "well, what it is then?". For the sake of clarifying our definition, conditions that would count as specific causes of back pain are:

  • having a tumour, malignant or not
  • having a fracture
  • having osteoporosis (which will most likely have caused a fracture)
  • the presence of a structural deformity (we're talking fused joints, misshapen bones, excessive spinal curves)
  • having an inflammatory disorder (diseases that affect your whole body, some of which particularly like attacking our joints and/or spine)
  • radicular syndromes - where a nerve has been damaged in or near the spine
  • cauda equina syndrome - as above, but related to a particular set of nerves that control your bowel, bladder and reproductive organs.

I would hope that having read that list, you might feel relieved to know that your back pain is "non-specific". You might even feel tangibly better, knowing that you don't have any of the above.

 

The bad news

Knowing that you have "non-specific" low back pain is a great first hurdle to clear in finding out what has caused, or is causing, your condition.

All too often however, the investigation stops here. This term "non-specific" seems to have been re-appropriated to suggest that there can not be any identifiable cause of pain. In turn, we shouldn't waste any further time or resources considering what might have caused the pain. Instead, let's discuss pain management and encourage people to stay active.

It just doesn't add up. Let's look at a typical example of cause and effect:

  • We see patients in clinic who are in huge pain, and who dislike bending forwards or sitting down. The pain wraps around them like a band, and grew over the course of around 24 hours after a seemingly innocuous sensation in their low back.
  • This clinical picture is indicative of a disc injury, and sometimes, we request some imaging for that patient.
  • When the report comes back, they have, guess what, an obvious disc injury - a bulge, herniation, prolapse or sequestration. 
  • We now have a pretty specific cause of their pain. But their pain is "non-specific" in medical jargon. Go figure.

Here's the disclaimer:

  1. We don't typically get imaging of patients with back pain just to confirm a disc injury. There will be other concerns that would have triggered us to seek imaging.
  2. All too often, back pain of complex origin is falsely blamed on a disc injury that is visible on imaging. The timeline of an injury and many other factors are needed to help us decide whether we can safely attribute a patient's condition to what we see in the images.

 

What's the use of this?

You might be reading this thinking that we're merely making a technical point. To some extent you are right.

But what scares us as experts in our field is how often people get left in no-mans-land between being told that their back pain is "non-specific" and yet not knowing any specifics about their "non-specific" back pain.

If patients are brushed off with pain medication and broad strokes of lifestyle advice, they are being denied basic knowledge that could help them hugely.

Patients who hurt bending forwards can be helped with one set of exercises, while patients who hurt bending backwards can be helped with another. But we do need that little bit of specificity when learning about their back pain in order to make that decision. 

Let's embrace "non-specific" back pain, be grateful to have cleared that hurdle, and then start dealing with the specifics. 

 

If this blog touches a nerve with you, we can only suggest that you get help from someone who knows back pain. GPs can help jump that first hurdle of ensuring you are in the "non-specific" category, but the experts are the manual therapists and spinal specialists. Please seek help from someone qualified, the sooner the better.

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