Too many people with low back pain get wrong Rx, authors say
Article series in The Lancet focuses on evidence-based care of condition that affects 540 million people globally.
Low back pain is the leading cause of disability worldwide, affecting an estimated 540 million people at any time. And too many patients being treated for back pain receive the wrong care, according to an international group of authors who have published a series of articles in The Lancet.
They point out evidence that indicates recent-onset low back pain should be managed in primary care, with initial treatment including education and advice to keep active and at work. In reality, though, a high proportion of those patients receives care in emergency departments. They are referred for radiological imaging, prescribed opioid medications, and encouraged to rest and stop working.
“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,” explained author Rachelle Buchbinder, a professor at Monash University in Australia. “Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.”
Co-author Judith Turner, a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, treats patients at the UW Center for Pain Relief. She offers cognitive-behavioral therapy, which enables patients to learn and apply behavioral and mental strategies that reduce pain and psychological distress, and improve sleep and the enjoyment of activities. She introduces patients to strategies such as measured breathing, muscle relaxation and imagery techniques. She helps them change how they think about pain.
Turner, president of the International Association for the Study of Pain, has researched back pain throughout her career. For The Lancet series, she assisted with a literature review and helped write the articles.
“Clinical guidelines recommend exercise and psychological therapies as first-line treatments for persistent back pain, but many patients are not prescribed exercise, and very few receive psychological treatments,” she said.
The authors said low back pain results in 2.6 million emergency department visits in the United States each year, with high rates of opioid prescription. A 2009 U.S. study found that opioids were prescribed in about 60 percent of ED visits for low back pain. Additionally, only about half of people with chronic back pain in the United States have been prescribed exercise. In India, studies suggest that bed rest is frequently recommended, and a study in South Africa found that 90 percent of patients received pain medicine as their only treatment.