More effective back pain treatment could reduce NHS bill

Published on 10 April 2012

Professor Elaine HayA major trial into the management of back pain run by the Arthritis Research UK Primary Care Centre at Keele University shows evidence that a stratified management approach to target the provision of primary care physiotherapy significantly improves patient outcomes and could save the NHS £120million per year.

Published in The Lancet, the internationally recognised new stratified management approach – STarT Back, could provide the basis for a new back pain pathway (a new health care system) and offer primary care providers an average saving of £34.30 per patient.

Findings from the Arthritis Research UK-funded study will now be shared at a one-day conference on Tuesday April 17, hosted at Keele University.

Current guidelines for the management of patients with non-specific low back pain adopt a ‘one size fits all’ model, irrespective of patient risk of persistent problems. However the problem for health professionals is spotting who is likely to get better with simple advice and reassurance, and who might benefit from further treatment. It is thought that back pain currently costs the NHS £4.2 billion a year.*

NHS Direct in Scotland has already decided to use the targeted approach and it is being used across NHS services in the UK (e.g. Sheffield, NHS South Central) and a number of other countries to form the basis for new back pain health care systems being developed.

The conference will share the STarT Back approach, including the STarT Back screening tool and matched treatments, with GPs, healthcare professionals and representatives from the Department of Health. There will also be the opportunity to discuss the implications for the commissioning and provision of service.

Chief investigator and director of the Arthritis Research UK Primary Care Centre at Keele University, Professor Elaine Hay, said: “The new STarT Back screening tool and targeted treatments we have developed is already proving popular in the UK and also internationally, with 50 centres adopting them. The data show that they have a substantial and beneficial impact when implemented, making a big difference to patients.

“What’s more, we have also found that this new targeted approach substantially reduced healthcare costs and therefore has important implications for commissioners and providers of back pain services.” 

Back pain is very common and it is estimated that for 11-12 per cent of sufferers back pain is severe enough to affect an individual’s quality of life, family and social relationships, and ability to work.** Current guidelines for GPs highlight the need to give good advice to patients about taking painkillers, avoiding bed-rest and continuing their daily activities, including staying at work. For most patients that is sufficient. However, some people don’t recover so quickly and might need referral to a physiotherapist for exercise or manual therapy, while others may need their fears and anxieties about their pain, motivation, mood and work situation addressing. The STartT Back model doesn’t assume that ‘one size fits all’ and as such allows clinicians to ensure treatments are targeted to the right patient.

“The problem for GPs and other health professionals is spotting who, amongst the patients they see with back pain, is likely to get better with simple advice and reassurance, and who might benefit from further treatment from a physiotherapist,” added Professor Hay.

The research involved more than 850 back pain sufferers and found that a more targeted approach, which is more reflective of patients’ needs, helps people with back pain take less time off work. And patients themselves were more satisfied with their care.

Crucially, those patients at highest risk of their back pain becoming long-term – because they are afraid that exercise will make it worse, for example - benefited from a more intensive approach that not only helped them with physical function but also addressed specific worries about their pain.

Medical director of Arthritis Research UK, Professor Alan Silman, added: “Improving the outlook for patients with back pain has been the subject of an enormous amount of research over several years, with physical and psychological approaches being trialed. This research is novel because it shows how to take the best of these two approaches, and make a real difference to large numbers of patients.”

*2008/9 ARMA 2010.
**Pain in Europe, 2003.

Back to fitness

Dr Jonathan Hill

A new questionnaire that takes just 30 seconds to fill in is having a big impact on the way people with low back pain are treated. Jane Tadman reports.