Too many back pain patients receiving the wrong care

26 March 2018

A global epidemic of inappropriate tests and treatments for back pain means patients are not receiving the right care, and resources are wasted, a new series in Lancet reveals today.

A new series of research papers published today in The Lancet by a team of Australian and international researchers, highlights the extent to which the condition is mistreated, often against best practice treatment guidelines.  The series reveals misconceptions about best practice are widespread among healthcare professionals, funders and patients themselves, and that medical guidelines are frequently ignored.

Macquarie University author Associate Professor Mark Hancock explained: “Low back pain is the leading cause of disability worldwide, affecting an estimated 540 million people at any one time – and causing more disability than lung, bowel and breast cancer combined. The burden from low back pain has doubled in the last 25 years, and the prevalence of the condition is expected to continue to increase with an ageing and increasingly obese population.”

Associate Professor Hancock points to the need to address widespread misconceptions in the population and among health professionals about the causes of back pain and the effectiveness of different approaches to treat or prevent back pain.

Other Australian authors of the Lancet series include Professor Chris Maher, Associate Professor Manuela Ferreira and Associate Professor Paulo Ferreira from The University of Sydney and Professor Rachelle Buchbinder from Monash University. The international team behind the series come from the UK, the US, Denmark, the Netherlands, Canada, Switzerland, Finland, Sweden, Brazil, South Africa and Germany.

Professor Maher from The University of Sydney said: “More care does not mean better care. More aggressive treatments for low back pain have little proven benefit and have the potential to make things significantly worse for patients. Evidence suggests that low back pain should be managed in primary care, with the first line of treatment being education and advice to keep active and stay at work.”

Monash University’s Professor Rachelle Buchbinder said: “The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work. Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.”

Associate Professor Hancock emphasised the need to replace expensive harmful treatments with cheap recommended approaches to manage low back pain such as patient education and exercise.

“A better understanding of low back pain, and changes to the way care for low back pain is delivered and reimbursed, are key to reversing the current problems.”

Back pain fast facts:

  • Around 25 per cent of Australians suffer from low back pain on any day
  • 50 per cent of Australians suffered from back pain in the past month
  • Australia spends $4.8 billion per year on management of low back pain
  • Back pain reduces Australia’s GDP by AU$3.2Billion per annum and is the most common condition keeping older Australians (aged 45-64) out of the workforce

What are the common problems with management of low back pain in Australia?

  • Most patients who see a GP for low back pain are prescribed a pain-killer but not provided with any advice or education on self-managing their condition
  • Although back pain is best managed out of hospital in community facilities, hospital admissions for back pain have increased in the last decade
  • An increasing number of people are calling an emergency ambulance when they experience low back pain rather than following guideline recommendations to see their GP, physiotherapist or chiropractor
  • In older people with back pain there is a trend for greater use of spinal fusion surgery despite evidence that this procedure is ineffective, costly and potentially harmful
  • Patients with low back pain are commonly encouraged to remain off work until pain-free, a practice that delays recovery
  • Medicare, has a limit of five allied health consultations, which is too few to deliver a typical exercise programme for chronic low back pain.

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