Research into Low Back Pain
March 21, 2018 -- Low back pain affects 540 million people worldwide, but too many patients receive the wrong care. Worldwide, overuse of inappropriate tests and treatments such as imaging, opioids and surgery means patients are not receiving the right care, and resources are wasted.
Low back pain is the leading cause of disability
worldwide, affecting an estimated 540 million people at any one time. Yet, a
new Series of papers
in The Lancet highlights the extent to which the condition is
mistreated, often against best practice treatment guidelines.
Researchers from Keele
University ’s Research Institute for Primary Care
and Health Sciences worked with colleagues at Warwick University
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.
NIHR Professor Nadine Foster, who is the lead
author of one of the papers in the Series, explains:
“The gap between best evidence and practice in low
back pain must be reduced. We need to redirect funding away from ineffective or
harmful tests and treatments, and towards approaches that promote physical
activity and function. We also need to intensify further research of promising
new approaches such as redesigning patient pathways of care and interventions
that support people to function and stay at work.”
The Series reviews evidence from high- and low-income
countries that suggests that many of the mistakes of high-income countries are
already well established in low-income and middle-income countries. Rest is
frequently recommended in low and middle income countries, and resources to
modify workplaces are scarce.
“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,” explains Series author Professor Rachelle Buchbinder,
Monash University, Australia. “Often, however, it is more aggressive treatments
of dubious benefit that are promoted and reimbursed.”
Low back pain results in 2.6 million emergency visits
in the USA USA USA India ,
studies suggest that bed rest is frequently recommended, and a study in South Africa
NIHR Research Professor Nadine Foster explains:
“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. As
lower-income countries respond to this rapidly rising cause of disability, it
is critical that they avoid the waste that these misguided practices entail.”
The Global Burden of Disease study (2017) found that
low back pain is the leading cause of disability in almost all high-income
countries as well as central Europe, eastern Europe, North Africa and the
Middle East, and parts of Latin America . Every
year, a total of 1 million years of productive life is lost in the UK because of disability from low back pain; 3
million in the USA ; and
300,000 in Australia
NIHR Professor Foster adds:
“In the UK ,
we know that lower back pain is very common, and accounts for 11% of the entire
disability burden from all diseases in the UK
The global burden of disability due to low back pain
has increased by more than 50% since 1990, and is due to increase even further
in the coming decades as the population ages.
Professor Martin Underwood, Warwick University
“Our current treatment approaches are failing to
reduce the burden of back pain disability; we need to change the way we
approach back pain treatment in the UK
Low back pain mostly affects adults of working age.
Rarely can a specific cause of low back pain be identified so most is termed
non-specific and evidence suggests that psychological and economic factors are
important in the persistence of low back pain. Most episodes of low back pain
are short-lasting with little or no consequence, but recurrent episodes are
common (about one in three people will have a recurrence within 1 year of
recovering from a previous episode) and low back pain is increasingly understood
as a long-lasting condition.
The authors say that health care systems should avoid
harmful and useless treatments by only offering treatments in public
reimbursement packages if evidence shows that they are safe, effective, and
cost-effective. They also highlight 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.
Series author Professor Jan Hartvigsen, University of Southern Denmark
“Millions of people across the world are getting the
wrong care for low back pain. Protection of the public from unproven or harmful
approaches to managing low back pain requires that governments and health-care
leaders tackle entrenched and counterproductive reimbursement strategies,
vested interests, and financial and professional incentives that maintain the
status quo.”
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