President's Report

Peter Werth

The Challenge of Chronic Musculoskeletal Pain
As chiropractors and osteopaths we manage acute musculoskeletal pain well via the use of manipulation/adjustment mobilisation and other forms of manual techniques. When we are talking about neck and back pain the evidence generally supports the use of such techniques in the acute and subacute phase of an injury.

What we do not necessarily do so well is manage chronic or persistent musculoskeletal pain. The evidence is far less convincing for the use of manual therapy procedures in the chronic population. If one uses standard definitions of chronic pain ie. pain lasting longer than 3 months, then we do see a lot of these people in our practices. Some patients may only present when the pain becomes too much to manage day-to-day, but the pain may be present to varying degrees most of the time. Some recent epidemiological studies have indicated that back pain that was thought to resolve by six weeks for 80-90 percent of patients, in fact does not completely resolve, but rather is present to varying degrees on an ongoing basis and tends to flare-up at times prompting patients to re-present for treatment. Anecdotally this would appear to be the case, as we may often see patients for a few visits and then they “disappear” for a while and then re-appear with a history of insidious onset or trivial onset of back pain again. There is also growing recent evidence that co-morbidities such as arthritis and mental health issues may also be present with these patients, and in these factors may predispose some patients to chronicity.

If we are to claim back pain as our forte then we by rights should manage all forms of the condition effectively, not just the “run-of-the-mill” cases. The current evidence supports the limited use of manual techniques in chronic back pain, but what other interventions have been shown to be efficacious and how should they be applied? – Good question.

If you haven’t already guessed where this is all going, it is to draw your attention to the COCA 6^th Biennial Conference in Melbourne in October with the appropriate theme of The Management of Chronic Musculoskeletal Pain. As you can see from our front page article we have secured one of the world’s leading authorities on the management of chronic musculoskeletal pain Professor Gordon Waddell as our keynote speaker. We will also hear from one of the leading chiropractic researchers Dr Mitch Haas Professor & Dean of Research, Western States Chiropractic College. Dr Haas and his colleagues have been looking at dose response effects of manipulation in chronic lower back pain as well as the efficacy of manipulation in this patient population. This research is vital for the professions to develop protocols for the chiropractic and osteopathic management of chronic back pain.

In conjunction with these overseas speakers we will have plenty of local talent looking at some of the interventions that have been found to be effective in the management of chronic back pain, especially the role of exercise and also the currently popular cognitive-behavioural therapy approach. We have an exciting Grand Rounds planned too, but it’s not all work, we will also be hosting a conference dinner that will be a great chance to meet our overseas guests as well as catch up with old and new friends.

Let’s ensure that we have a good grasp of how to manage these patients that present to our practices, so that we can play a positive role on how these people manage their persistent pain.

The conference brochure with the full program will be mailed shortly. I hope to see you in October.