I am working with another article from the Duke Medicine Health News this month. How many of you have had a bout or a number of times with low back pain (LBP) Dan and I had numerous ones in our younger years. Since we have become more mature, neither of us has had any LBP. We do thank the Lord for this. If you haven’t had LBP, I’m sure you know any number of persons that have had or have LBP.
Almost 80 percent of patient visits to general practitioners and primary care physicians for LBP result in the patient receiving care that is not endorsed by international evidence based guidelines, according to a large recent Australian study. In the U.S. LBP is the fifth most common reason to visit a physician and the cost is over $50. Billion.
THE PROBLEM “Advice and simple analgesics” is the first line of treatment recommended, but the study found that only 20.5 percent of patients, received this care, meaning that the majority of patients-received care outside the established guidelines. “Advise, recommended in international guidelines constitutes: Stay active and avoid bed rest; reassure the patient that they have a favorable prognosis_ie.,highlight the simple nature of back pain and that most people recover from it.” The study found patients were given nonsteroidal anti-inflammatory drugs (NSAIDs), and opiods instead of simple analgesics. The guidelines discourage imaging, but more than 25 percent of patients were referred for imaging as a first line of treatment. A comparable study in the U.S. found that imaging actually increased from the Australian study. The imaging is not only costly but the patients are being unnecessarily exposed to radiation.
THE FIX One approach is to educate large numbers of general practitioner on the efficacy of the guidelines and also that they should encourage adherence among physicians which isn’t happening now.
TAKE HOME MESSAGE “Sometimes we can overcomplicate medical care,” said a Mr. Williams. “ For acute back pain, it is best to start with simple treatment delivered well. It is only when this does not work that you should consider more complex and costly treatments. Patients and clinicians can be reassured that adding more treatments and tests from the outset won’t speed recovery. It only increases costs and the risk of side effects...
