Back pain

Back pain is a major health problem, affecting over one third of the adult population. Persistent back pain affects quality of life, family and social relationships, and the capacity to work. Our research investigates the prognosis of back pain using novel methods to describe trajectories of pain and disability in primary care patients with back pain, taking into account the episodic nature of symptoms and the wide variability in trajectories between patients.  In our NIHR Programme Grant (Optimal management of spinal pain and sciatica in primary care) we use quantitative and qualitative methods to investigate the experience of living with back pain, and obstacles to recovery from across the biopsychosocial model, including the presence of leg pain, psychological factors, family, and work-related factors, and use the results to develop interventions to improve outcomes in patients with back pain.

We have developed a novel approach to the management of back pain by using prognostic tools (eg. STartTBack Tool) to stratify patients according to their risk of poor outcome and offer targeted individualised treatment, including delivery of Cognitive Behavioural Therapy by enhanced scope practitioners to those groups at highest risk of chronicity. Initial studies suggest that adopting a ‘subgrouping for targeted treatment approach’ for back pain, is both clinically and cost effective and the centre is currently evaluating if such an intervention can be successfully implemented in routine clinical practice.

Our current back pain studies:

Observational studies

  • Long term back pain trajectories and family influences
    Funded by the Wellcome Trust( 2000 – 2003 and 2008 – 2013)
  • Diagnosis and prognosis of back pain with associated leg pain (ATLAS)
    Funded through an NIHR Programme Grant (2009 – 2014)

Randomised clinical trials

  • Subgrouping and targeted treatment for low back pain (STarT Back Trial)
    Funded by an Arthritis Research UK Project Grant (2007 – 2010)
  • Implementation study of targeted treatment for back pain (IMPaCT Back)
    Funded by the Health Foundation (2007 – 2010)
  • Supporting return to work in back pain patients in primary care (SWAP back) 
    Funded through an NIHR Programme Grant (2009 – 2014)