The Back Pain Revolution, 2nd edition

Book Review by Jonice Owens, DC

Title:

The Back Pain Revolution, 2nd edition

Author:

Gordon Waddell

Publisher:

Churchill Livingston, 2004

Part #:

T-257

The Back Pain Revolution by Gordon Waddell is a densely packed, well-written, updated text from an author who greatly influences modern American medicine. The author is a bastion of knowledge in the orthopedic surgical community, and a proponent of including segments of the innovative medicine into the mainframe of the old medical model. He appears willing to call the disease model into question.

The book contains 22 chapters. Waddell begins by posing "the problem," which is how to cope with the "20th-century medical disaster and the legacy reverberating into the new millennium: back pain." He proceeds with his approach, called the diagnostic triage (chapter 2), devotes a chapter to differentiating pain and disability (chapter 3), then presents historical background, epidemiological information, risk factors, and the charting of the clinical course of back pain in the ensuing four chapters. He then ties this information together into physical impairment (chapter 8) and the anatomical and physical basis of back pain (chapter 9). Chapters 10 through 13 lend background to the emotional and psychosocial aspects of back pain, with chapter 14 tying all of these components together to present a "biopsychosocial model." Chapter 16 offers detailed and friendly information and advice for patients. Clinical and occupational health guidelines comprise chapters 15 and 17. An important chapter on rehabilitation (chapter 18) precedes UK and U.S. health care approaches for back pain (chapters 19 and 20), and chapter 21 outlines the expected future of health care for back pain. Chapter 22, an epilogue/recap, is also worth reading.

This text serves as an excellent resource for various aspects of a musculoskeletal-based practice. This book would serve as background resource material in medical-legal disputed cases when dealing with attorneys, medical health care providers, insurance administrators and other chiropractic physicians. Much of this information could be obtained via literature searches and Internet access. However, this 475-page volume packs all of the information in and would be an effective, time-saving device, as well as an instructional tool.

Dr. Waddell has promoted many ideas in the arena of low back pain. He includes many of his well-known contributions (illness behavior, biopsychosocial model), as well as newer information on the neurophysiology of pain, the origin of dysfunction, pain management, rehabilitation, and evidence-based medical practice.

The format is varied, with the inclusion of questionnaires, flow charts, diagrams, photographs, and historical memorabilia. These accessible, comprehensive, easy-to-follow lists highlight the text.

Because The Back Pain Revolution is written by an orthopedic surgeon for manual medical professions and those interfacing this arena, a chiropractic doctor might find the review too rudimentary. Many basic chiropractic college courses (and almost any postgraduate chiropractic course) have covered material found within these chapters. We've come a long way from the days when chiropractic medicine was negated by Western medicine. However, Waddell continues to use the term "orthodox" medicine interchangeably with Western medicine, and chiropractic care is lumped in with osteopathy, physical therapy and manual medicine in the "Holistic Approach" section. Each discipline is relegated separate columns/subsections to advise regarding each practice history, orientation and current contribution to physical medicine. This inclusion appears to be prompted by popular demand, indicating the stalwart's adaptation to change. It is interesting to know what the current mainstream thinking is regarding chiropractic; however, this interest may not warrant the extensive reading required, nor the cost of the text.

In spite of Waddell's efforts to update the contents, he does not include updating of offensive and demeaning terms such as "cripple" ("Why and how do some people become chronic back cripples due to ordinary backache?"). In contrast, he will split hairs over other terms such as functional capacity evaluation. "FCE is also misnamed. It is not an evaluation of capacity but of performance, so it still depends on effort. I also have doubts about some of the methods used in FCE to access effort and symptom magnification." An additional potential pitfall lies in clinical relevance of this text for the U.S. audience. This is avoided with chapter 20, "U.S. Health Care for Back Pain."

This well-written text for modern medicine deserves a 10 out of 10. In terms of relevance to chiropractic physicians, as a whole, I would give it a 9 out of 10.

Dr. Owens' Rating:

9 out of 10