Lowering Back Pain Myths

By Áine Freeman

Dr Mary O’Keeffe has become the first University of Limerick graduate to win a Marie Sklodowska-Curie Fellowship from the European Commission, awarded for her research into lower back pain as a physiotherapist. Dr O’Keeffe began studying for her bachelor’s degree in physiotherapy because of a love of sport and a desire to treat sports injuries but she quickly realised it was the research side of her degree she enjoyed most.

“When I came to UL, a lot of the course was about pain science, research and the evidence for certain treatments and it was this aspect of the course that appealed to me most,” Dr O’Keeffe explains.

She was inspired to research back pain because of the prevalence of myths surrounding the condition.

“A lot of what I thought was true about back pain before starting my degree turned out to be completely wrong when I was exposed to the science of it. It was fascinating. That made me reflect that if I’m thinking that way about back pain, a lot of the public must think that way too. There are many misconceptions about back pain but, when you examine the evidence, they are not backed up. The unfortunate thing is these myths drive unnecessary fear over diagnosis and treatment, which all fuel increasing disability and reduced recovery.

“When people get back pain, there is a tendency for people to wrap it in cotton wool. This is now shown to be unhelpful. We don’t see this with other body parts. Changing poor beliefs on a societal level should be a target for all back pain researchers,” she says.

Dr O’Keeffe continued her research at PhD level. “I applied for a PhD through the Irish Research Council to research lower back pain. My research group was looking at a more multi-dimensional, holistic approach to back pain, where you consider the physical, psychological, lifestyle and social aspects of a person’s back pain and associated disability to see is this better than usual care,” she recalls.

Exercise is the best preventive strategy for back pain but probably underused. Medications don’t speed up recovery and don’t have strong benefits but they are given out as easily as sweets.

As part of this research, patient trials were conducted. “We carried out a clinical trial in three HSE centres in Ireland, which involved recruiting people with chronic low back pain. We measured certain things, for example their pain, their disability, their fear, their mood, how long they’d been off work and so on, before starting treatment. Measurements were taken after treatment and again six and 12 months later. People were divided into two different treatments - one would get our one to one multi-dimensional treatment and the other would complete exercise and education in a group setting. We wanted to see is one approach superior to the other.”

Dr O’Keeffe’s view on lower back pain and how it should be treated has now changed completely. “Back pain is as common as the cold and most people worldwide will get it at some point but 98% of it is not dangerous or serious. Most of it will run its own course without the need for treatment. This should come as a huge comfort to the general public, with the key thing being not to panic.

You can have back pain without back injury.

 “This was a huge shift in my thinking, as we now know that pain can be driven by multiple things, including physical, psychological, health, lifestyle and social factors. All pain is 100% real, even when non-injury factors are involved. For example, bed rest was a thing I thought would be good before my physiotherapy degree but now we know this is very unhelpful. Staying off work is unhelpful for back pain, so people should be encouraged to return to work as soon as possible. Exercise is the best preventive strategy for back pain but probably underused. Medications don’t speed up recovery and don’t have strong benefits but they are given out as easily as sweets.

“This idea that we need to sit in a particular posture or we need to sit straight, that hasn’t been found to be true at all. We’re finding that there actually isn’t any ideal posture. The back is a very strong structure, it isn’t like a Jenga game, where pieces like discs or bones randomly fall in or out. It is rock solid. Unfortunately, the general public don’t know these things and this needs to change. They need to be informed of the science,” she outlines.

Completing her PhD in June 2016, Dr O’Keeffe was awarded a Marie Skłodowska-Curie Fellowship from the European Commission in January 2017. These prestigious fellowships are presented to researchers who show great potential to make a difference in their field.

Through this fellowship, Dr O’Keeffe will carry out further research at University of Sydney, supervised by Professor Chris Maher, the world leader in low back pain research.

“When I go to Sydney, I will be doing advanced analysis of my PhD trial, for example medication and costs. Also, I will be getting involved in other projects which I wouldn’t have access to here, for instance, I’ll be involved in drug trials, exercise trials and research into over-diagnosis and over-treatment,” she says.

The fellowship also means she is receiving more media coverage, something she hopes to use to spread her findings to a larger audience. She will begin her two-year research fellowship in Australia next January.

“I’ve been in UL for eight years now, so I think going to a new group will be great. I’m really looking forward to it”, Dr O’Keeffe concludes.