Low back pain – resources

Today, I had a chance to participate in a discussion facilitated by Nepal Physiotherapy Association on low back pain over Zoom and was broadcasted on the association's official Facebook Page. I was very happy with the active engagement of everyone (other speakers and audiences). Very interesting questions were raised, and as promised, I am sharing some important reading materials for low back pain in a single page. I know that this may not be an exhaustive list but only a selected reading guide for low back pain.

To learn about the details of low back pain, I would really encourage you to read the papers on the Lancet series on low back pain published in 2018. The papers can be accessed from the journal website, here. I strongly urged the audiences and other panel members to use a diagnostic triage to rule out red flags for low back pain. 

This paper is very well written, and it consolidates evidence around the diagnostic triage and informs treatment pathways. There are several clinical practice guidelines on back pain that you may read, in addition to the Lancet series papers shared above. These guidelines include ones from the USA, UK, and Canada for example.

Many questions from the audience were related to lumbar radiculopathy or sciatica. Here is a brand new paper summarising physiotherapy interventions for sciatica.

This study we conducted on low back pain in Nepal provides some local Nepalese context on back pain (some self-promotion here, but it does provide some helpful tips on providing education and guideline-based care for low back pain). Some helpful guides for the prevention of pain (resources developed by the International Association for the Study of Pain translated into Nepali) can be found on the IASP website, here.

REMEMBER, education and reassurance is the key to the management of non-specific picture, therefore this picture.

Some validated instruments you may use for the assessment of low back pain are published in Nepali (and some are in process of being published). The names of the instruments and information on how to access them are provided below:

1. Numerical Pain Rating Scale to assess pain intensity. The scale is located in the additional file in the paper on the Journal website. You do not need permission to use this. If you are using it for research, please cite this paper. This is an open-access, free to download paper.
2. Faces Rating Scale-Revised is another scale to assess pain intensity, most suited for older adults, or children, or those with lower levels of education. In a study, we found that patients with musculoskeletal pain in Nepal prefer Faces Rating Scale over the Numerical Rating Scale to assess their pain intensity. Numerical Rating Scale should be reserved for younger and educated people. Download the Nepali version from here.  Please cite this study in order to use it for your research.
3. Global Rating of Change to assess patients' perceived improvement. The scale is located in the additional file in the paper on the Journal website. You do not need a permission to use this. If you are using it for research, please cite this paper. This is an open-access, free to download the paper.
4. Patient-Specific Functional Scale to assess physical function. The scale is located in the paper as an Appendix. You do not need permission to use it in clinical practice. If you are using it for research, please cite the paper. This is not an open-access paper, please write to me to request for the full paper.
5. Pain Catastrophizing Scale can be used to assess pain catastrophizing or worries about pain. The paper is free to download but to use the scale, you will need to seek permission from Mapi-Trust. Mapi-Trust is kind enough to waive the fees to use for clinic or non-commercial purpose. Please complete the request online.
6. Oswestry Disability Index can also be used to assess disability due to low back pain. Not all the measurement properties have been tested yet. Like the Pain Catastrophizing Scale, you will require permission from Mapi Trust to use it.
7. Connor-Davidson Resilience Scale can be used to assess an individual's resilience to an adverse event (such as low back pain). The scale can be requested from the developer to use for your clinical practice or research from the Questionnaire website.
8. Other PROMIS scales (five of them) have been translated and validated. We are currently writing the full manuscript. It was published as a conference abstract.

To identify whether you, or your patient is at risk for long term back pain, you may use PICK-UP tool online, which will help you predict persistent pain.

Try using these scales in your patients, you will learn so much about your patients that you would have generally missed.

Please feel free to write for any questions at saurabsharma1@gmail.com

Happy reading! 

Saurab 

View my Google Scholar Profile for more studies from Nepal.