"Referral Diagnosis Low Back Pain: Only the Tip of the Iceberg" managing pain from a MDT perspective



Chair: Bart Morlion, Belgium

Presently, chronic low back pain (cLBP) is considered as a bio-psychosocial phenomenon, meaning a combination of physical dysfunction, injuries, beliefs, coping strategies, distress, illness behavior and social interactions. This conceptual framework, supported by a wealth of scientific evidence, implies a multimodal and interdisciplinary treatment approach with the aim of maximizing pain reduction, quality of life, independence and mobility. Nevertheless, in many health care systems this knowledge is ignored and a plethora of treatments, mostly focused on peripheral anatomical targets, are offered at great cost to the public health care. At the same time modern multimodal approaches are only sparely offered at great individual cost to the patient. A vignette of a female patient referred to a pain center for the management of chronic low back pain will be discussed by team members of the Leuven Centre for Algology. They will analyze this complex case, formulate an interdisciplinary advice to the referring physician and start multimodal pain rehabilitation. The role of the flag system and imaging in the assessment of LBP will be discussed together with technical interventions and rehabilitative strategies. This case illustrates the sobering reality that medical daily practice often neglects the bio-psychosocial model of cLBP. An urgent need for synchronization of medical practice and modern concepts of cLBP is warranted. On the other hand, it shows that interdisciplinary approaches can help our chronic back pain patients to live a more valued life, despite some level of ongoing pain.

Koen Bernar, Belgium

Susan Broekmans, Belgium

Eline Coppens, Belgium

Peter Van Wambeke, Belgium

Hilde Verbeke, Belgium

Sofie Verbruggen, Belgium

Elfi Vergaelen, Belgium