Worrying Trends in Low Back Pain

The treatment of back pain has been taking up a lot of scientific press recently with some trends that are worrying doctors.

Around 90 percent of us will experience lower back pain at some stage in our lives with 25-35 percent of the population having back pain at any one time. New research from Australia indicates lower back pain is now the number one most disabling health condition above others including diabetes, depression, pulmonary diseases and arthritis. It’s a big problem.

Despite this, the way back pain is currently being treated is failing, putting peoples health at risk and costing a lot more than it should, according to recent studies out of the US, Australia and Spain.

Clinical guidelines for doctors recommend to encourage patients with non-specific back pain (over 90 percent of lower back pain is non-specific) to remain as active as possible, reassure and educate, and use simple pain killers as a starting point.

Instead, there has been an increase in referrals to specialist surgeons (up 106 percent); an increase in the use of advanced imaging (MRI, utra-sound) of close to 60 percent; and an increase in use of powerful medication (narcotics) of over 50 percent. At the same time, prescription of simple pain medication has decreased by over 50 percent.

The release of this information coincided with a presentation of a study conducted in the UK. It found an alarming number of patients with cardiovascular disease risk factors are being inappropriately prescribed non-steroidal anti-inflammatories (which include ibuprofen – Nurofen, diclofenac – Voltaren). The danger being that recent studies have shown these drugs increase the risk of death through cardiovascular disease with long and short term use. Also of note is the major increase in prescribing more complex and unnecessary medication which has resulted in a 200 percent increase in deaths in the US involving opioid analgesics over the last decade.

At the same time, only 20 percent of people with lower back pain were provided with advice, education and reassurance of a favourable prognosis as suggested by best-practice guidelines.

Half of those who experience an episode of lower back pain will have a recurrence of the pain within the next year. Professor Maher summarised research that indicates it is unusual to have back pain only once in your life. He also suggested the treatment of lower back pain should be similar to the way a common cold is treated, accepting people will get it but learn how to manage it more effectively.

The solutions put forward are good common sense. They talk about addressing the underlying cause of the problem, combatting mis-information by providing effective education and endorsing a commitment to a regular exercise plan. This happens to be BodyLab’s successful approach for years!

References:

Worsening Trends in the Management and Treatment of Back Pain. John N. Mafi; Ellen P. McCarthy; Roger B. Davis; Bruce E. Landon. JAMA Intern Med. 2013;173(17):1573-1581. doi:10.1001/jamainternmed.2013.8992.

NSAID Prescriptions for Pain ‘Out of Control’. Alice Goodman. Retrieved October 15, 2013. http://www.medscape.com/viewarticle/806368?src=nl_topic&uac=38244DV

Back pain: time to get it right? Professor Chris Maher, George Institute for Global Health. Retrieved October 31, 2013 http://sydney.edu.au/medicine/21st-century/presentations/LBP-21st-century-challenge_Oct%201.pdf

Richard Trendle M.Sc, Exercise Physiologist

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