Too many back pain patients receiving the wrong care

22 March 2018
A new series in the Lancet, featuring University of Sydney authors, reveals a global epidemic of inappropriate tests and treatments for back pain, such as imaging, opioids and surgery.

Today, a Lancet series of papers on back pain and a new 2.5 million NHMRC Centre for Research Excellence will launch a response to worldwide concern that too many back pain patients are receiving the wrong care, to the detriment of patients and healthcare systems.

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 aging and increasingly obese population

Led by a team of Australian and international researchers, the Lancet series published today, highlights the extent to which low back pain 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.

University of Sydney author Professor Chris Maher said millions of people across the world are getting the wrong care for low back pain.

“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 at work.

“However, in reality, a high proportion of patients worldwide are treated in emergency departments, encouraged to rest and stop work, are commonly referred for scans or surgery, or prescribed pain killers including opioids, which are discouraged for treating low back pain.”

Australian authors of the Lancet series include Professor Chris Maher, Associate Professor Manuela Ferreira and Associate Professor Paulo Ferreira from The University of Sydney; Professor Rachelle Buchbinder from Monash University and Associate Professor Mark Hancock from Macquarie 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.

Associate Professor Manuela Ferreira said health systems currently fund tests and treatments that are unnecessary, ineffective and often harmful such as X-rays, scans, opioids, injections and surgery.

“But they don’t fund interventions that are helpful including physical and psychological therapies for chronic low back pain.”

Associate Professor Paulo Ferreira said: “The series highlights the need to address widespread misconceptions in the population and among health professionals about the causes, prognosis and effectiveness of different treatments for low back pain.”

Also announced today, a $2.5 million NHMRC Centre of Research Excellence (CRE) for the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network to be run jointly by Monash University and the University of Sydney.

The CRE, launched by the Federal Health Minister, Hon Greg Hunt MP, will be a collaboration of more than 200 clinician-researchers from 21 universities, 21 hospitals and ten research institutes. The aim of ANZMUSC is to optimise musculoskeletal health by addressing the lack of high quality research that has been focused on arthritis and musculoskeletal conditions, despite these conditions affecting 28 per cent of Australians.

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.

“We need better access to low-tech, cheap recommended approaches to manage low back pain such as patient education and exercise, which need to replace expensive harmful treatments,” she said.

“There is room for hope here,” added Professor Maher.

“There are safe effective treatments for low back pain, the challenge is ensuring patients get the right care at the right time.

“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 problems we see now.”

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
  • Up to one third of physiotherapists endorse the use of outdated and ineffective forms of treatment for their patients
  • Most chiropractors incorrectly believe that imaging is required for patients with acute low back pain
  • 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 being encouraged by their GP 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
  • GPs who report a special interest in low back pain are more likely to provide the wrong treatment for low back pain.

Kobi Print

Media and PR Adviser (Health)

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