Since the 1960s, cardiac rehabilitation has been the gold standard to prevent subsequent heart events. It encompasses multiple factors like graded mobilization, risk reduction, nutritional counseling for weight and lipid reduction, psychological and vocational counseling, smoking cessation, stress reduction and self-responsibility. Cardiac rehabilitation team members have included physicians, cardiologists, therapists, nurses, nutritionists and psychologists.
The same multifactorial approach should be routinely employed for "back attacks" for the same reasons; if a patient continues to live in the same way, he or she risks a repeat of the medical events.
In the case of my own "back attack" and multitudes of patients who sustain them, there is little rationale to obtain diagnostic imagery unless red flags are present. Conservative treatment with one to two days of bed rest, followed by reactivation, medications and thermal modalities (cold/heat) for comfort and physical therapy over a period of 2 to 6 weeks, are sufficient.
I believe a back pain paradigm based on the heart attack paradigm can help the millions affected by repeated episodes of lower back pain in understanding their condition and susceptibilities and preventing further "back attacks." Rather than "medicalizing" an attack of lower back pain or a "back attack," this new paradigm would help patients avoid the current odyssey of multiple surgeries, injections and chronic opioid use--which only worsens pain as it adds to health care and societal costs.
This is an excerpt from Multidisciplinary Management of Chronic Pain: A Practical Guide for Clinicians available from Springer.
www.springer.com/us/book/9783319203218
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