Back Pain
Excerpts from the East of England Citizen Senate Discussions
Last week we discussed Back Pain. What it is and how it impacts lives. Back pain costs the UK economy an estimated £10–12 billion per year. This includes the direct costs of treatment within the NHS and the indirect costs of lost productivity, absenteeism, and welfare payments.
The meeting focused on pain management, specifically addressing back pain causes and treatments. Participants shared personal experiences with back conditions, including severe disc problems requiring surgery and ongoing issues despite treatment. The discussion covered various treatment approaches including physiotherapy, hydrotherapy, acupuncture, and alternative methods like yoga and Pilates, with participants noting limitations in current NHS services and the challenges of accessing effective treatment. The conversation also touched on the importance of proper posture, prevention through childhood development, and the role of the placebo effect in medical treatments. Insights about interoception versus introspection were shared and the distinction between pain and suffering, while participants discussed how modern lifestyle factors like sedentary behaviour and technology use may contribute to back problems. The conversation ended with reflections on prayer and meditation practices as complementary approaches to pain management.
Back Pain Diagnosis and Treatment
The group discussed the economic impact and causes of back pain in the UK, sharing personal experiences with back issues and treatments. Personal experience of a back injury from an accident and subsequent surgery was shared, highlighting the limitations of current treatment options and the benefits of hydrotherapy. The discussion touched on the challenges of accessing hydrotherapy due to cost and limited availability, as well as changes in physiotherapy practices over the years. The group noted that while hydrotherapy can improve mobility, it is not typically used to cure underlying problems but rather to aid in movement and exercise.
The group shared personal experiences and challenges with accessing appropriate treatment. An incident was shared regarding a back injury which was initially misdiagnosed, due to a doctor's dismissive attitude, leading to inadequate treatment. The conversation highlighted systemic issues in healthcare, including the constraints of 10-minute doctor appointments and the lack of comprehensive physical treatment options for back problems within the NHS. The increase in non-medical requests at GP practices was highlighted and the social prescribing and other options now available at GP practices. Also under the new GP total triage system there is the option for longer GP appointments enabling a more holistic approach to general practice.
Participants also discussed alternative treatments like acupuncture and physiotherapy, with a positive experience being shared regarding back and shoulder issues. The discussion concluded with practical advice on managing and preventing back pain, including proper posture and positioning.
Posture and Musculoskeletal Health
The group discussed the importance of posture and musculoskeletal health, with insights from a health survey conducted with Polish people about child annual check-ups. They explored various approaches to managing back pain, including exercises, posture awareness, and alternative treatments like acupuncture, with participants sharing personal experiences about effectiveness. The discussion highlighted concerns about overreliance on pain medication and the role of psychological factors in treatment outcomes, while also touching on the Egoscue Method as a potential approach for addressing postural issues.
The Placebo Effect in Medicine
The discussion then shifted to an exploration of the placebo effect in surgery and medicine sharing how a significant portion of treatment efficacy comes from patient belief rather than the treatment itself. The conversation concluded with a personal experience of learning acupuncture techniques and philosophical perspectives on scepticism versus evidence-based approaches to alternative medicine.
Modern Lifestyles
Emphasis was made on how modern lifestyle factors like excessive snacking, sedentary behaviour, and technology use affect children's health. The discussion included a discussion on whether humans were designed to be bipedal or quadrupedal, though this was set aside as the main focus remained on preventing back problems and managing pain without relying heavily on painkillers.
Pain Management and Posture
The group discussed pain management options, with an advocate for Pethidine based on personal experience with spine pain, and unable to understand why it is not more commonly used. The conversation then shifted to posture and body alignment, with participants sharing experiences about posture training in schools and the challenges of maintaining correct posture, particularly how it can initially feel uncomfortable and cause fatigue. The discussion included practical advice about leg crossing and sitting positions, with participants noting some recommendations against crossing legs due to creating spinal alignment issues.
Posture and Health
The group discussed the impact on a person’s health of posture and sitting, with participants sharing personal experiences about knee problems, circulation issues, and the challenges of maintaining good posture for extended periods. It was argued that modern chairs enforce unnatural human posture, which has detrimental health effects, while others noted the importance of movement and good circulation. The conversation also touched on mealtime practices, with participants agreeing on the benefits of sitting at tables for family meals and digestion, though acknowledging that modern lifestyles make this challenging.
Health and Wellbeing Management Approaches
The group discussed various approaches to managing health and well-being, including the importance of proper body alignment, mindfulness practices like yoga and tai chi, and the distinction between pain and suffering. The concept of interoception versus introspection was shared, highlighting its relevance in meditation practices and its potential benefits in prayer. The conversation also touched on the impact of technology on attention spans and the preference for slower-paced content.
Resources
Interoception is the "eighth sense" that allows us to perceive, interpret, and respond to internal body signals, such as hunger, thirst, heart rate, breathing, pain, and body temperature. Often called our "inner body sense," it plays a crucial role in self-regulation, emotional health, and maintaining homeostasis.
Key Aspects of Interoception:
• Body Signals: It detects signals from organs like the heart, lungs, and stomach, as well as muscles and skin.
• Emotional Regulation: Interoception connects physical sensations to emotions (e.g., butterflies in the stomach when nervous), helping us understand how we feel.
• Impact on Well-being: Strong interoceptive awareness aids in self-regulation and mental health, while poor awareness can lead to challenges with pain management, anxiety, and daily functioning.
• Differences in Processing: Some people struggle to notice these internal cues, which is common in neurodivergent individuals (e.g., autism, ADHD).
Examples of Interoception in Daily Life:
• Hunger/Thirst: Noticing a rumbling stomach and knowing it means you need to eat.
• Temperature: Feeling cold and knowing to put on a jacket.
• Emotions: Feeling your heart rate increase and recognizing it as anxiety or excitement.
Improving Interoception
Interoception can be improved through mindfulness practices, specialised exercises, and body awareness techniques.
Hydrotherapy (or aquatic therapy) is a form of physiotherapy conducted in warm, waist-to-chest-deep water (usually 33-35°C), designed to rehabilitate, strengthen, and relieve pain. It is excellent for back pain because buoyancy supports body weight, reducing joint/muscle strain, while warm water eases muscle spasms and improves circulation.
Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive, high-energy acoustic wave treatment used since 1980 to treat musculoskeletal pain and break down kidney stones (lithotripsy).
Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive, drug-free pain relief method using a small, battery-powered device to deliver low-voltage electrical currents via skin electrodes. It treats acute and chronic pain (e.g., muscle spasms, arthritis) by stimulating endorphin release and blocking pain signals to the brain.
The Egoscue Method is a personalised, non-medical posture therapy designed to eliminate chronic pain by realigning the body through "E-cises"—gentle, targeted movements. Founded by Pete Egoscue, it targets the root cause of pain, rather than symptoms, by addressing musculoskeletal imbalances, scoliosis, and structural issues through tailored, progressive routines.