Research Programme

Two-fifths of adults have experienced back pain at some time in the past year and the peak incidence is in people in their 30s, 40s and 50s. BackCare, the new name for the National Back Pain Association, is a Registered as National Back Pain Association, Charity (no 256751) which was established in 1968. We are the leading national charity, concerned with reducing the impact of back pain. We promote self-help and mutual support for those with back pain and our aims are to:

• provide practical and emotional support for people through our specialist helpline and self-help branches
  
  
• educate people to prevent back pain through information booklets and posters and campaigns such as BackCare Week
  
  
• raise awareness of the incidence, treatment and prevention of back pain in industry, the medical profession, employers and government
  
  
• fund research into the causes of and improved treatments for back pain.

New research projects being funded 2002

• Is sciatica and related back pain an infection? Professor Tom Elliott at Queen Elizabeth Hospital, Birmingham, is keen to find out if some back pain may be caused by a bacterial infection. His study will involve obtaining samples of vertebral discs from patients already undergoing surgery for unremitting back pain and sciatica. The samples will be tested using a range of molecular and immunological techniques which have been developed by the Hospital, Royal Orthopaedic Hospital and Aston University. This research will be funded by BackCare and a special hospital endowment fund.
  
  

• Programme to undertake a systematic review of the effectiveness of acupuncture for back pain. At the moment it is unclear whether acupuncture is an effective treatment for low back pain and BackCare is funding a programme that will collect and review all the material available with the aim of reaching a reliable conclusion. Lasting for one year, the programme will be lead by Dr Adrian White from the School of Sport & Health Sciences, Department of Complimentary Medicine, University of Exeter.

• Specifically related to an Emergency Service and researching the effectiveness of an educational intervention to encourage positive beliefs and behavioural changes for back pain management. Lasting for two years, this programme will be undertaken by Ms Ann Parry, Department of Health & Social Care, Brunel University and King's College Hospital. The results will be published and will be available as a template for other occupational health services and organisations.

• An investigation, lasting two years, into the role of interleukin-1 in intervertebral disc degeneration. Studies of the molecular biology of the diseased intervertebral disc (IVD) have shed new light on the distributed cell biology that leads to degeneration of the IVD (DIVD). Headed by Professor Anthony Freemont of the Musculoskeletal Research Group at the University of Manchester School of Medicine, BackCare is jointly funding this research programme with a Manchester NHS Trust.

Recent and ongoing research Includes:

• Evaluation of a Primary Care Audit Toolkit to aid implementation of the UK National Guideline for acute low back pain.   Low back pain remains a condition associated with high levels of disability and cost. The Royal College of General Practitioners (RCGP) produced national evidence-based guidelines for acute low back pain, but implementation of these guidelines has been slow.
  
  Researchers at the Institute for Musculoskeletal Research & Clinical Implementation (IMRCI) developed an audit toolkit for the RCGP guideline in collaboration with colleagues from the fields of general practice, chiropractic, osteopathy and physiotherapy. 914 practitioners have successfully tested the audit toolkit on more than 6,000 patients. It was designed as an aid to implementation and to give a quality assurance process for use of the RCGP national guideline. In September 2000, all Clinical Governance Leads in English and Welsh Health Authorities were sent a copy of the audit toolkit. Corresponding post-holders in the primary care groups and trusts were also informed of its availability.
  
  This current research project at IMRCI consists of a survey of these groups to establish their opinions regarding the toolkit and its level of utilisation. Researchers are also seeking to identify any specific administrative, clinical or political barriers to the implementation of the guideline and its audit process in primary care. Publication of results is scheduled for Spring/Summer 2003.
  
  
• The effect of a muscle stabilisation programme in patients after surgery (to be funded by BackCare and the Chartered Society of Physiotherapy, for completion March 2003). We are now beginning to understand the role of exercise in treating low back pain and this study will be the first to see the effectiveness of exercise programmes following disc surgery. Outcomes following surgery for prolapsed discs are quite poor, often leading to 'Failed Back Syndrome'. It is thought this is due to muscles wasting away and to other damage caused by inactivity before and after surgery. Addenbrooke's NHS Trust will be encouraging people to take part in exercise programmes after surgery.
  
  
• A community based perspective on back pain. (Completed) Leeds University's Philip Helliwell will be tracking back pain in adults living in Bradford. He will use questionnaires to monitor how many people have back pain and what impact it is having on their lives.
  
  
• An investigation into epidural pain relief during labour and chronic back pain (North Staffordshire Hospital Trust and Keele University, published BMJ August 2002 ). No causal link has been found which is excellent news for expectant women, anaesthetists and the medical profession.
  
  
• The development of the first school bag designed by leading ergonomists to reduce the risks to young spines of carrying heavy loads to and from school. The unique padded lumbar curve has been patented and the rucksacks are being manufactured on behalf of BackCare and are on sale in the UK and Ireland.
  
  
• An investigation into nutrition and the development of the vertebral canal (Complete, University of Aberdeen) using a unique collection of data on the diets of expectant mothers and their children stretching back for over 40 years. The study showed that low birthweight is an important factor in reducing the size of the vertebral canal and that maternal smoking is detrimental to canal development.
  
  
• Real time imaging of the spine during manipulation (completed 2000, published 2001). Manipulation of the spine is now accepted as an effective treatment for many back conditions, although it has not been possible to view what is happening to body tissues during the therapy. This study by Imperial College School of Medicine is to find out whether magnetic resonance imaging and new fast track imaging systems can be used to see actual changes to the spine, and if so, whether it is possible to determine who is likely to benefit from manipulation. The study showed that mobilisation caused little if any movement of the underlying bones, but marked compression of the soft tissues.
  
  
• A review of psycho-social factors. Research indicates a link between chronic back pain and factors such as dissatisfaction with work, family difficulties and poor self-reported health. Researchers at Royal Holloway University of London reviewed the evidence published to date to identify the most consistent factors in predicting chronic back pain. They concluded that there was good reason to suggest that psychological factors (particularly depression/distress) interfered with recovery and therefore should be tackled early.
  

Donations towards this research or to our services for people with back pain will be gratefully received.

BackCare is a member of the Association of Medical Research Charities.