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Low back pain sufferers 'often receiving inappropriate care'

Published on 06 April 2018
Low back pain sufferers 'often receiving inappropriate care'

More and more people are suffering from low back pain worldwide - an issue that is being made worse by the widespread prevalence of inappropriate treatment methods.

This is the conclusion of a series of new scientific papers published by The Lancet, which have reviewed evidence from high and low-income countries, finding that this is a global problem that can only be solved through better adherence to best practice treatment guidelines.

A global problem exacerbated by ineffective care
The first of these new reviews revealed that low back pain is now the leading cause of disability on a global basis, with the issue becoming more prevalent over time, particularly in low and middle-income countries.

It is most common and burdensome in working populations, with many older people finding that their back pain prevents them from taking part in daily activities. Although most cases of low back pain are short-lasting, recurrences are common, with the costs associated with back pain-related healthcare and work disability shown to be enormous.

Part of the reason for this was highlighted by the second review, which revealed significant discrepancies in the types of treatment given to these patients. In many cases, sufferers receive emergency care for their pain and are encouraged to rest and stop work, contrary to medical recommendations; they are also commonly referred for scans or surgery, or prescribed painkillers such as opioids, which are discouraged for treating low back pain.

Professor Nadine Foster, professor of musculoskeletal health in primary care at the Arthritis Research UK Primary Care Centre at Keele University, was the leader of this second review. She said: "In many countries, painkillers that have limited positive effect are routinely prescribed for low back pain, with very little emphasis on interventions that are evidence-based, such as exercises. As lower-income countries respond to this rapidly rising cause of disability, it is critical that they avoid the waste that these misguided practices entail."

The importance of proven treatment options
These reports underline the importance of ensuring that low back pain sufferers receive the right care - a point emphasised further by the third review, which reminded healthcare providers that simple physical and psychological therapies that keep people active and enable them to stay at work are usually best.

Patients should be empowered to self-manage their conditions and avoid unnecessarily aggressive treatment wherever possible, supported by a medical system that understands what works in the management of low back pain and what doesn't.

The STarT Back tool, developed by Arthritis Research UK, was cited as an example of an intervention that can help with this. It is a clinically proven questionnaire that GPs can use to assess an individual's physical, psychosocial and psychological risk factors for chronic back pain, making it possible to deliver targeted treatment for each patient's needs.

Arthritis Research UK's view
Dr Natalie Carter, head of research liaison and evaluation at Arthritis Research UK,
said: "This review highlights the global toll that lower back pain takes on healthcare systems and the economy. But behind these statistics are real people living with pain that can make everyday life incredibly difficult.

"This review reinforces many things we have been championing for years - including how GP services treat lower back pain and support people to stay active and continue to work. Pain varies from person to person, and not everyone will benefit from the same treatment and advice. That's why we've invested in STarT Back - a tool that GPs can use that helps them identify the treatment most likely to work on a patient-by-patient basis.

"If you are worried about your treatment or feel it is ineffective, please do speak to your GP."

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