Spinal pain: current understanding, trends, and the future of care

Gregory F Parkin-Smith,1 Lyndon G Amorin-Woods,2–4 Stephanie J Davies,5–7 Barrett E Losco,8 Jon Adams9,10 1General Practice, Surgery 82, Busselton, WA, Australia; 2School of Health Professions, Murdoch University, Murdoch, WA, Australia; 3Chiropractors’ Association of Australia, Nedlands, WA, Australia; 4ACORN Project, 5WA Specialist Pain Services, WA, Australia; 6School of Physiotherapy, Curtin University, Bentley, WA, Australia; 7School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia; 8Murdoch University, Murdoch, WA, Australia; 9Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia; 10Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, Australia Abstract: This commissioned review paper offers a summary of our current understanding of nonmalignant spinal pain, particularly persistent pain. Spinal pain can be a complex problem, requiring management that addresses both the physical and psychosocial components of the pain experience. We propose a model of care that includes the necessary components of care services that would address the multidimensional nature of spinal pain. Emerging care services that tailor care to the individual person with pain seems to achieve better outcomes and greater consumer satisfaction with care, while most likely containing costs. However, we recommend that any model of care and care framework should be developed on the basis of a multidisciplinary approach to care, with the scaffold being the principles of evidence-based practice. Importantly, we propose that any care services recommended in new models or frameworks be matched with available resources and services – this matching we promote as the fourth principle of evidence-based practice. Ongoing research will be necessary to offer insight into clinical outcomes of complex interventions, while practice-based research would uncover consumer needs and workforce capacity. This kind of research data is essential to inform health care policy and practice. Keywords: back pain, pain management, combined modality therapy, patient care tea