I could not believe my eyes when I saw a headline in The British Muddical Journal (13 October 2023) proclaiming some great news: ‘GPs can refer patients with low back pain to apps, says NICE‘. So now at last we have the answer to this ubiquitous problem: apps! The object of this wonderful move is to help these patients ‘self-manage their condition’ and it will also have the benefit of ‘reducing pressure on NHS services.’

Wishing to learn more about this exciting development, I read on and discovered the following:

GPs and other health professionals would be able to refer patients aged 16 years and over to seven apps that provide support for new non-specific back pain or back pain that has lasted more than three months.

The over-used word, ‘support‘, for back pain sufferers could perhaps refer to the provision of corsets, but that’s not what they mean.

Low back pain is clearly a serious problem because, we are told, ‘There are 9.11 million people living with long term back pain in England, and musculoskeletal conditions account for 30 per cent of GP consultations.’ Further, a certain Mark Chapman, the ‘interim director of medical technology and digital evaluation at NICE,’ no less, says: ‘We believe these technologies have the potential to offer people with low back pain quicker access to the care they need.’

The care they need? Not only is this proposal yet another indication of the bankrupt general state of knowledge in low back pain, but I regard it as an insult and a scandal. It amounts to doctors saying to patients with the symptom of low back pain (apart from those with rare serious causes) that they have nothing to offer. No, that isn’t quite true. It’s a new way of passing the time whilst hoping for spontaneous recovery.

Seven such apps are listed. They are all self-management programmes for chronic (long-lasting) pain, but why do some people develop this condition in the first place? They don’t wake up one day with chronic pain. It means untreated or refractory acute pain. (Acute pain starts suddenly or develops over a short period of time.)

In patients with so called non-specific low back pain, whether acute or chronic, the pain must be arising somehow, so why is the present ‘state of the art’ almost a counsel of despair? As I have mentioned before, it’s as if we’re in the situation depicted in George Bernard Shaw’s comedy, The Doctor’s Dilemma, where the surgeon Sir Cutler Walpole treats all his patients by removing their nuciform sac. Nowadays doctors are recommended to treat the patient’s non-specialium, a hitherto undiscovered structure to be found in the lower back of patients with pain in this part of the body, with an app.

What most doctors don’t seem to realize is that, on the contrary, it’s usually straightforward to diagnose patients with low back pain and treat them effectively – if you know how to do it. This approach was pioneered by Dr James Cyriax but now, alas, his work is almost forgotten. For more details about this remarkable man and his work, readers are referred to my other blogs about him on this site and chapter 13 of my medical memoir, An English Doctor in Japan.

Text © Gabriel Symonds

Picture credit: Sara Kurfess on Unsplash