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Pain management

Treatment for low back pain often not following evidence, researchers warn

A series of articles published in The Lancet has shown that a high proportion of people living with low back pain are being given treatments outside of best practice guidelines.

Patients with low back pain are commonly subjected to a raft of treatments which are not recommended, a series of articles in The Lancet has highlighted.

Overuse of imaging, opioid painkillers and surgery is not only against best practice guidelines, but also a waste of resources, researchers warn, adding that people are frequently given the wrong advice.

Figures cited in the articles show low back pain as the leading cause of disability worldwide, affecting around 540 million people at any one time.

Yet, despite evidence showing it should be managed in primary care, with first-line advice being to keep active and working, a high proportion of patients are encouraged to rest and stop working. Patients are often prescribed painkillers (including opioids), and are treated in emergency departments before ending up referred for scans or surgery.

Series author Rachelle Buchbinder, from Monash University in Australia, said most cases respond to simple physical and psychological therapies.

“Often, however, it is more aggressive treatments of dubious benefit that are promoted.”

Co-author Nadine Foster, professor of musculoskeletal health in primary care at Keele University, added: “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.”

The authors say there is a need to address widespread misconceptions about back pain in the population and among health professionals.

Roger Knaggs, an advanced pharmacy practitioner specialising in pain management, and a spokesperson for the Royal Pharmaceutical Society, said low back pain is very complex and when it continues for some time, the psychological and emotional factors become much more important.

He added that community pharmacists were in a good position to provide evidence-based advice and educate patients.

“Primary care and GPs are under an awful lot of pressure and have limited amounts of time to see patients, so issuing a prescription can be the easier thing to do — and from the patient point of view it is what they expect as well, so hence that disconnect,” he said.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204599

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