Chronic low back pain

I'm going to a pain clinic now to try and help me with my chronic low back pain. Everyone seems convinced that the answer is exercise. I like to exercise and I always have, but it doesn't really seem to make a difference in my level of pain. How come I'm not getting the same results as everyone else?

You may be getting the same results but you just don't know it. According to a recent review of many studies on exercise for low back pain (LBP), only a fraction of people get the positive results reported.

This over-reporting of conclusions is fairly common. The statistics show one thing but the actual clinical results don't match up. This means that treatment effects are over estimated.

The reasons this happens can vary. Sometimes the number of people in the study is too small to really measure treatment effect. But the data is analyzed and the statistics look very favorable.

In other cases, the researchers use a very narrow change in measures to show a positive result. This statistical tool is called the minimally clinically important difference. If pain and motion are the main measures of results and an improvement of one per cent is used, the results will look better than if 10 per cent improvement is required to show a positive effect of the treatment.

If exercise alone isn't helping, then adding one other treatment at a time may help sort out what works and what doesn't for you. Sometimes there is a particular combination of treatment that works best for an individual.

Finding that best match may take some time and lots of trial and error but it can be done. Take good notes or keep a daily log to help you look back on your own results and see what's working for you.

Maurits van Tulder, PhD, et al. Statistical Significance Versus Clinical Importance. In Spine. July 15, 2007. Vol. 32. No. 16. Pp. 1785-1790.

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