An Interview with Dr Adam Al-Kashi of the Charity BackCare
As a corporate sponsor of the charity BackCare I thought I would ask Dr Adam Al-Kashi, their new Head of Research, a few questions about back pain, the work that the charity does and Adam's role in it. The result below is, I hope, useful for those suffering from back and neck pain and also those advising them.
If I wake up in the morning and can't get out of bed due to back pain, what is your advice?
Take an anti-inflammatory analgesic drug such as ibuprofen, which most people tend to have at home, and wait for the pain to subside. Once you’re feeling a little better, it’s important to get out of bed and keep active. Nothing strenuous, but you need to just keep moving. Pottering about the house is perfect.
If a GP says I should take an aspirin and rest for a few days is that the best advice?
Again, the evidence we now have suggests that remaining motionless is not going to help, and will makes things worse in the long run. Take a break from strenuous or vigorous activity, but don’t just lie or sit still. There’s also evidence to support the use of topical heat or cold application.
What help is available on the NHS. I have heard that in some areas you can get osteopathic treatment on the NHS. Is this true?
There can be considerable tension when medicine meets medicine, and best practice may appear to be beyond the financial constraints of the primary care trust (PCT). However, more worrying can be the disparity between evidence and attitudes, whereby a kind of institutionalised inertia can hinder the adoption of change. The NICE guidelines recommend that GPs offer exercise, acupuncture or manual therapy for persistent non-specific lower back pain. However, survey data reported by PULSE http://bitly.com/PULSEsurvey, the general practice news portal, found prevalence amongst PCTs of the opinion that these services were low-priority, controversial and to be used in exceptional cases. Having said that, there are examples of more embracive PCT cultures, such as the North East Sussex PCT http://bitly.com/NorthEastSussex, where patients being consulted for lower back pain lasting at least four weeks can choose to be referred to a chiropractor, osteopath or physiotherapist from the private sector.
I have heard a lot of people say that no one can tell them what is causing the problem yet their life is ruined by pain. Are they medical mysteries for which there is no cure?
There is a difference between the unknown and unknowable, and I think that ‘medical mysteries’ may say more about the practitioner than the ailment. We’re always increasing in the ways we understand medicine, and it’s important not to let old dogmas get in the way of new and useful approaches, especially when backed by evidence. A sadly still prevalent misconception is the idea that physical ailments can only have physical causes, when volumes of research data make it clear that the brain and mind are simply part of the whole human organism. There are abundant connections between the four primary organismic systems, namely psychology (the mind), neurology (the brain, spine and nervous system), endocrinology (the glands and hormones), and immunology (the lymphoid tissues/ organs and white blood cells). I’m always learning, and one of the most enlightening approaches I recently encountered was that of the SIRPA organisation http://www.sirpauk.com, which is using psychology to end chronic pain syndromes for which there is no physical explanation. The founder, Georgie Oldfield is a BackCare Professional which is how I learned about the work that they are doing. Unfortunately there is still a huge stigma attached to psychology and people can react quite strongly against the suggestion that their physical ailment has psychological correlates. But perceptions change – the world used to be flat.
If people have a niggling pain in their back but it is not stopping them doing anything yet what should they do now, to prevent real problems in the future?
Don’t ignore it or put up with it. Treat this as a warning signal. Seek professional diagnosis. Seek professional lifestyle advice, including ergonomics – for example have your desk, office chair and car seat looked at. A small adjustment maybe all that is required so don’t let it escalate. The nervous system learns how to perceive persistent pain more efficiently by making new neuronal connections, and longer you leave it, the bigger the underlying problem you may end up facing.
If an employer is not helping me improve my workstation/ method of work and this is adding to my back pain. Is there anything I can do?
This can be a tricky one. Depending on the culture within your work place, many people do not feel it ‘wise’ to question the ‘hand that feeds them’ so to speak. But at the end of the day, this is an important health issue. Proceed in a diplomatic and flexible manner, rather than through head to head confrontation, if possible. Your employer may simply not fully appreciate the risks involved or that prevention is better than lost productivity through sickness absence. The bottom line is that the Health and Safety (Display Screen Equipment) Regulations 1992 make it a legal requirement for employers to have your workstation assessed and deal with the outcome.
Who can I ask about exercise that won't make things worse or what exercises to do to make things better?
Every case of back pain is different, and no single exercise regimen will be the best recommendation for everyone. Seek diagnosis and advice from a professional such as a chiropractor, osteopath, physiotherapist, Alexander Technique practitioner or Pilates practitioner with the Government's REP Level 4 certification.
How can I find medical help that really understands what I am going through?
A dedicated professional who has seen and successfully treated many people with musculoskeletal pain syndromes is your best bet. But also, don’t neglect the emotional burden of chronic pain, since what you’re “going through” is basically how it makes you feel. Depression is common amongst chronic pain sufferers, and the prolonged experience of negative emotions is itself bad for your health. Don’t be afraid to seek out psychological assistance for your sense of wellbeing.
Are there local support groups where I can talk to others and get advice from fellow sufferers?
Yes, BackCare has more than a dozen local support groups up and down the country, some of which have been running for many years. These groups have traditionally been offline, but we’re in the process of transitioning on to the online ‘Meetup’ platform. I would actually recommend that you check out Meetup http://www.meetup.comin general, which I think is an excellent way to find people who share your own interests and experiences, and after all your health is a 'biopsychosocial' matter.
My back pain is such that I am starting to feel a bit depressed. What can I do?
Depression and negative emotional states have a huge impact on wellbeing. Never consider a low quality of life to be acceptable. People are mostly trapped by what they believe to be possible. If you have been told, or are telling yourself, there is no hope, you are unlikely to ever challenge the boundaries of your own reality. It’s very important to take positive action. I say “positive” action because many people fall into the trap of obsessively seeking out people and stories that agree with their current state of hopelessness. They may learn to identify very strongly with their ailment to the point that they will resist and fight of any attempt to be shown otherwise – this is a dangerous position to enter into because you are now actively maintaining or even accelerating your ill health, rather than open-mindedly seeking help. Stay physically active and stay open to the understanding that sometimes facts are merely opinions. Seek out differing opinions, ones that challenge what you believe to be the case. And, of course, again, don’t be afraid to address your emotional wellbeing in an appropriate manner, through the help of an appropriate professional or method.
I want to talk to someone now. Who can I call?
BackCare runs a helpline (0845 130 2704) that offers support to back and neck pain sufferers, and perhaps particularly those who are in need of emotional support rather than just information. In fact, we’re seeking to expand the service that we’re able to offer and are in need of new volunteer helpline operators. Readers who are interested and have a proven background in counselling or related disciplines are more than welcome to get in touch with me (firstname.lastname@example.org).
What is your role at BackCare?
I’m the Head of Research at BackCare. I’m also the editor of our quarterly TalkBack magazine http://www.issuu.com/backcare, and the manager of the helpline.
What is on your 'to do' list for today?
Today, I’m writing up some research reports for the next edition of TalkBack, and working on a new education programme that we hope to have up and running soon.
Do you get back pain yourself?
From time to time, I get back pain. In the past, I’ve had some episodes that felt quite serious to me, but I’ve since learned to understand how pain is a response, and how I respond to specific kinds of physical and psychological stressors. Educating yourself about yourself, or ‘self knowledge’ if you like, is crucial. I still get minor backache but it is quite different now, and I understand it simply to be an indicator that tells me to take certain actions or address the way I am thinking or feeling. For me, nutrition and exercise and sleep were quite obvious factors to address, but none of these were as impactful as psychology which sits above these. I’m very thankful that I’ve never suffered a traumatic injury to my back or neck.
How many corporate sponsors of BackCare are there?
We currently have partnerships with more than thirty corporate entities. Many of these are manufacturers, distributors or retailers of back health-related products, but it also includes several educational and training organisations.
Can you summarise what BackCare wants to achieve?
Back and neck pain is an enormous problem that is greatly underappreciated by many individuals and organisations. In fact, it accounts for more than half of all pain and many billions of pounds are wasted every year in the cost to the NHS as well as the cost to the economy through days lost at work. But beyond that, I think that we are part of a global culture and society where chronic pain is built into our institutionalised lifestyles and work practices. BackCare’s mission is to use research, education and innovation to change that.
How do you use your sponsors to achieve this?
We are very grateful to our sponsors who are kind enough and insightful enough to help us achieve our mission through the donation of money, time, skills and ideas.
How many people do you help each year?
It can be hard to really quantity the impact of what we do. There is the direct impact of our publications, online activities and helpline that I would estimate to be in the tens of thousands. Then there is the impact of our educational campaigns and research activities. These are part of a longer-term approach where I’d estimate an impact in the hundreds of thousands to millions. In fact, it doesn’t need to be difficult to change lives. A campaign that gets mainstream television coverage can easily reach millions. Our ongoing school bag campaign recently made it on to news channels in the UK, Spain and New Zealand.
There were some people running the last London marathon for BackCare. Would you consider doing this?
We had a tremendous turnout this year, with nearly thirty runners in the BackCare marathon team. And after witnessing the event in person for the first time, I decided to sign up for next year. I’ve never really been a runner so this is the perfect opportunity. I’ve already started training for next April and it feels great!
To contact Adam Al-Kashi of BackCare
tel 0208 9775474
To contact Mike Dilke of Back App UK
tel 01727 757221