Back Pain

Short Video Helps Patients Understand Causes, Treatment of Back Pain

When lower back pain strikes, people are often left wondering what the cause is, whether it will get better and what they can do to help themselves recover. Given the number of important structures in the back, including vertebrae, spinal discs and nerves, it’s easy to assume the worst. However, most cases of back pain are muscular in nature. This means that imaging tests and invasive procedures are likely not indicated.

Dr. Mike Evans, a primary care physician based in Toronto, created an 11-minute instructional video to help back pain patients get a better grasp on their conditions. He uses the concepts of red and yellow flags to teach patients what to expect and what to avoid in terms of diagnosis and treatment methods.

Red flags are symptoms that indicate a severe spinal problem, calling for the use of diagnostic imaging tests and potentially invasive treatment methods. Dr. Evans assures patients that the vast majority of people do not have red flag symptoms.

Red Flags

  1. Signs of Neurological Damage: sudden change in bowel and/or bladder habits; numbness in the groin area

  2. Signs/Risk of Infection – fever; IV drug use; compromised immune system

  3. Signs/Risk of Bone Fracture: traumatic injury; osteoporosis

  4. Signs/Risk of Cancer: history of cancer; constant pain; unexplained weight loss

  5. Signs of Inflammatory Disease: pain throughout the night; morning stiffness improving with movement

Much more common, and of most pressing concern to most back pain patients, are yellow flags. This concept denotes symptoms that increase the likelihood of pain transitioning from acute (short-term) to chronic (long-term).

Yellow Flags

  1. The belief that all pain is harmful

  2. Avoidance of activity due to that belief

  3. Low mood/isolation

  4. The expectation that passive treatment is sufficient to relieve pain. Passive treatment entails work done by medical professionals without active involvement by the patient.

Dr. Evans states that 90% of patients with acute back pain will recover shortly. Yet some transition to chronic pain even without a spinal condition because they aren’t active enough. Evans emphasizes movement as the best form of medicine for most back pain cases. He suggests developing a “resilience plan” that incorporates a structured exercise routine – be it walking, yoga, Pilates, etc. – with one or more of the following approaches:

  • Spinal Manipulation (chiropractor or osteopathic physician)

  • Massage

  • Acupuncture

  • Cognitive Behavioral Therapy (particularly helpful for those with chronic pain)

Evans’ final bit of advice to patients is that they acknowledge but not focus on pain. This means avoiding the yellow flags of negative beliefs and attitudes toward pain and adopting a proactive approach.

Watch Dr. Evans’ video at

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