Low back pain is the leading cause of disability in the US and the world. Treatments for back pain have escalated to the most expensive medical problem.
Why do some experience back pain for just a few days while others develop chronic symptoms and even disability?
A recently published research article looked into this very question. Researchers found that 32% of those with low back pain go onto have lingering or chronic symptoms. This large prospective study then went on to outline the contributing factors that lead to prolonged symptoms. The risk of transition to chronicity was associated with early care not aligned with current practice guidelines.
Evidence-based practice guidelines for the treatment of low back pain include the following:
- Early access to proper care that includes:
- Mechanical Assessment to determine directional preference.
- Care that focuses on patient education, empowerment, and functional activity.
- Advice to stay active and at work, as able.
- Psychosocial factors are assessed and addressed.
- Screen for any red-flags and provide appropriate referral/ further testing.
Non-Guideline Care that increases the risk of low back pain becoming a chronic condition:
- Pain medications including opioids
- Passive care
- Referral to a specialist
- Radiographs (x-ray, MRI, CT Scans) – unless indicated to rule-out red-flags / pathologies.
The data found that 48% of those with LBP received at least one “non-guideline” treatment within three weeks of their initial visit or care.
Specifically:
- 30% received prescriptions for non-recommended medications (65% opioids)
- 24% received radiography (MRI/CT scan)
- 6% referred to a specialist
When are we going to change these common and harmful protocols?
Those with low back pain should first be screened and treated by a musculoskeletal specialist. Further testing and referral to a physician should only occur if symptoms are found to be non-mechanical. Medication, radiographs, and referral to a specialist are still common protocols and must be used with more caution. Instead of initially seeing a physician, musculoskeletal pain should FIRST be screened and treated by musculoskeletal specialists, who are trained to differentiate mechanical from non-mechanical symptoms.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776518
