Treatment of low back pain needs to change as evidence shows current methods are not reducing burden

Following a series of papers, published in The Lancet and featuring contributions from Professor Martin Underwood of Warwick Medical School, the NHS has published recommended changes to the treatment of low back pain.

The series of papers highlighted how low back pain is mistreated — oftentimes against best practice guidelines. It is suggested that low back pain be managed in primary care, however, real-world evidence reveals that a high proportion of patients worldwide are treated in emergency departments, encouraged to rest and stop work, commonly referred for scans or surgery, or prescribed pain killers including opioids.

Evidence from high- and low-income countries was reviewed in the series of papers, revealing 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.

“Our current treatment approaches are failing to reduce the burden of back pain disability,” Underwood commented. “We need to change the way we approach back pain treatment in the UK and help low- and middle-income countries to avoid developing high-cost services of limited effectiveness.

“Quite a lot of people get exposed to high-tech medical and invasive procedures. There's very little evidence base to support their use.”

An analysis of NHS data, performed for The Times, has also found that patients with low back pain have been receiving more injections of steroids despite guidelines from the National Institute for Health and Care Excellence (NICE) stating the procedure should not be performed.

“We’ve had two sets of guidelines saying ‘don’t do it’ but it continues to go up,” Underwood said when speaking with The Times. “If you are doing this then you are denying people the opportunity of treatments that we think do work… It may be slowing up their recovery by keeping the, away from active things.”

Additionally, the data also highlighted an increase in the number of patients receiving surgical intervention from the 2012–2013 figure. Although surgery is recommended in some cases where serious injury has occurred for example, it may not be beneficial to a patient with low back pain from facet joints or discs.

“I would totally agree that if you have back pain and a specific cause is not clear, surgery is not the way forward yet some surgeons do undertake that surgery,” explained Mike Hutton, a consultant surgeon who leads an NHS project to help spinal units improve, when talking with The Times. “Patient expectations have become very, very high. I understand why. There’s a perception that we should be able to cure everything and sometimes we just can’t… We all want a quick fix. But I wouldn’t want an operation on my spine unless it had a good percentage chance of helping my symptoms with relatively low risk.”