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In the United States, more than 80% of adults will experience low back pain at some point in their life. Injury, working in a job with lifting or standing for long hours or a job where there is too much sitting – all can cause back pain. Many people go on to experience chronic back pain. They receive various treatments including surgery, therapy, injections and medicines including pain medications like opioids.
DR. GWEN SOWA
Over the last decade, there has been a rise in prescriptions for and addiction to opioid medication. The National Institutes of Health (NIH) has encouraged more research into understanding pain and its treatment. In 2019, Dr. Gwen Sowa of the University of Pittsburgh and UPMC received funding as a part of NIH’s BACPAC Research Consortium on back pain, part of the HEAL initiative (Helping to End Addiction Longterm). This initiative is advancing research to address the national opioid public health crisis. Opioids are often prescribed for low back pain. These are strong and addictive medications that have been overused (sometimes misused). Opioids are not the right medicine for chronic low back pain.
Instead of these dangerous painkillers, Dr. Sowa and her team focus on how chronic back pain is experienced and tailor treatment to the triggers. Dr. Sowa is both a doctor of rehabilitative medicine and has a PhD in biochemistry. She studies ways to treat people based on their individual symptoms and history. “Precision medicine means finding an approach that is tailored to an individual,” she says. The goal is to reduce unnecessary treatments and find the right combination of treatments early on so that the pain does not become an ongoing problem.
The “Low Back Pain: Biological, Biomechanical, Behavioral Phenotypes Mechanistic Research Center” (LB3P MRC) is trying to make treatment for low back pain better. The study collects lots of information about how you move your body, how you sleep, your energy and mood levels and even markers in blood and saliva that may point toward improved treatment targets. This information helps to put patients into distinct back pain groups. This way, the center improves personalized treatments while reducing use of opioids.
Most low back pain does not require surgery. Nor are medications like opioids the right treatment. Low back pain is a mixture of symptoms – it’s not due to one single cause. So the health care providers should not take a “a one size fits all approach.” One of the mistakes often made is relying solely on x-rays or even an MRI. Studies confirm that what these images show often are not associated with the source of pain.
Given that there are so many causes for back pain, there are also many different barriers to healing. These barriers include having access to a healthy lifestyle, diet, smoking, mood and safe neighborhoods in which to walk and exercise.
The types of jobs that many Black/African Americans have in our region are physically demanding, like construction. Compared to White residents, individuals who are Black also work in lower-paying jobs that require sitting all day such as driving or call centers. So the type of job people have can increase chances of having low back pain. In the context of the COVID-19 pandemic, the many stressors related to employment and housing have increased depression and reduced physical activity. These factors also make back pain more likely or more severe.
Once diagnosed with back pain, people who are not White also may experience differences in care. Studies show that people who are Black or other non-White ethnic backgrounds are undertreated. This means they do not get referred for management of pain as often as White patients. People may describe their pain differently depending on their cultural and language backgrounds. Health care providers may have biases that affect who gets treatment and who doesn’t.
Dr. Sowa notes that addressing these disparities in treatment is a critical aspect of their research. Back pain is complex and can be related to how people move (biomechanical), how their body responds to injury (biological), and lifestyle factors (behavioral). That is why everyone’s treatment needs to be considered at an individual level, taking all these factors into account.
Dr. Sowa focuses on teamwork. She says, “Lots of different experts are needed to help solve the complex problem of low back pain.”
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