Back pain being mismanaged globally

According to a panel of international health experts, back pain is being grossly mismanaged globally. This could be both by ineffective treatments as well as treatment with harmful methods.

The journal Lancet published three papers in a series that show that low back pain has been on the rise globally and is one of the leading causes of disability today. The reports in the three studies note that the healthcare providers depend too much on scans, surgeries and opioid pain relievers for management of low back pain. The team suggests that low back pain can be more effectively and safely managed with less invasive physical and psychological therapies.

Image Credit: Syda Productions / Shutterstock
Image Credit: Syda Productions / Shutterstock

The first paper titled, “What low back pain is and why we need to pay attention” is led by Jan Hartvigsen, Mark Hancock, and colleagues who explore the social, psychological and physical aspects of back pain. The second paper titled “Prevention and treatment of low back pain: evidence, challenges, and promising directions” led by Nadine Foster, Christopher Maher, and their colleagues speaks about the treatments available and the preventive measures for back pain. The third paper titled “Low back pain: a call for action” by Rachelle Buchbinder and her colleagues calls upon the medical fraternity to take notice and suggests ways to deal with this problem more effectively.

According to the papers, years lived with disability caused by low back pain has risen by 54 percent since 1990 to 2015. This could be due to rise in the aged population, sedentary lifestyles, new technologies, urbanization etc. the authors speculate. Back pain affects an estimated 540 million people globally, they write.

The authors of the studies including Monash University researcher, Professor Rachelle Buchbinder, one of the lead study authors, write that what is necessary is a “radical shift in thinking”. She said that a “tipping point” has been reached when it comes to the burden of low back pain. The condition is increasing rapidly and is being poorly managed medically. This harms and overburdens not only the patient but also the healthcare system she said. Low back pain care should be evidence based she said and back pain need not be treated as an injury but an issue that can be effectively managed as it waxes and wanes with time. The paper states that Australia spends $4.8 billion annually on low back pain management and it reduces the Australia's GDP by $3.2 billion a year. At least half of the Australian population is affected with low back pain.

Professor Chris Maher, lead author of one of the papers said that we need a deeper understanding of the problem and what can be done about it. He said that the “right care at the right time” was what the patients needed. He said that back pain is not an emergency medical condition but most people visit the emergency department for their back pain. Surgery such as spinal fusion has a limited role in back pain management he said, but is being recommended widely.

Prof Martin Underwood from Warwick University’s medical school, one of the authors says that only 1 percent of all low back pain cases are due to serious underlying causes such as a cancer or an infection. In many sufferers there are lifestyle problems such as obesity, smoking and sedentary lifestyles that contribute to the back pain. The episodes are short and do not last long. Only once third of the back pain sufferers may have a recurrence of the pain within one year, he said.

Professor Buchbinder, in her paper writes that the United States is facing an opioid addiction crisis mainly because of the rampant use of opioids to treat pain when it could be managed alternatively. She says in her paper that these “ineffective and potentially harmful treatments” waste limited healthcare resources and also cause harm.

One of the studies also states that all cases of low back pain are investigated with an MRI scan. Experts say that while MRIs can pick out physical problems, they cannot always detect the source of the pain. These scans are usually a precursor to surgery or other interventions they write.

Prof Nadine Foster from Keele University, one of the authors also said that the problem is real and these studies draw attention to the problem. The authors of these studies she said, were trying to find and show case better solutions rather than depending on high tech interventions and surgeries. She said that in this respect, the NHS was faring better than the US. Surgery rates were fewer here she added. Opioid pain killer use however remained high. She said the best idea is the give “the safest possible drugs for the shortest possible time at the lowest possible dose”.

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