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Common ailments Back pain: too often, patients are treated incorrectly


Back pain is a health and economic problem

Over 540 million people worldwide suffer from back pain, but many receive the wrong treatment, a team of English researchers found in a study. The key messages of the study are:

  • Current approaches to treating back pain are inefficient.
  • Back pain causes massive failures.
  • Doctors too often prescribe the wrong treatments.
  • Medicines with opiates are only partially effective for back pain.
  • Targeted sports activities are used too rarely for back pain.
  • The researchers are calling for a conceptual redesign of the treatments.

An English team of researchers from Keele University, in collaboration with healthcare organizations around the world, are reporting on maladministration in the treatment of back pain. These range from the excessive use of unsuitable tests, the prescription of incorrect treatments and medications to unnecessary operations. The study results appear in a three-part series in the specialist journal "The Lancet".

Back pain - the most common cause of disability worldwide

Back pain is the most common physical limitation worldwide and affects an estimated 540 million people. The current research shows to what extent the disease is treated incorrectly. The treatment methods used often contradict the guidelines for back pain.

Wrong advice

The scientists were able to show that in practice the wrong treatments are often prescribed and doctors often give wrong advice. The guidelines recommend providing information and advice on physical activity. Instead, many patients are put to rest and on sick leave. Violent pain relievers, including opiates, are often used. In addition, people with back pain too often perform various scans or operations.

The gap between ideal treatment and common practice

Professor Nadine Foster, one of the main authors of the study, explains the gap that exists between ideal theoretical treatment and real practical application. "We need to move funding away from ineffective or harmful tests and treatments," said Foster in a press release on the study results. Instead, approaches to physical activity and function need to be encouraged.

New approaches

Foster calls for further research on new, promising approaches that aim to better help people with back pain, to enable them to live a more productive life and to remain functional for longer in the workplace.

Back pain from an economic perspective

The “Global Burden of Disease” study from 2017 thematized that back pain is the main cause of disabilities in almost all high-income countries such as Central Europe, Eastern Europe, North Africa, the Middle East and parts of Latin America. In total, the UK has a million years of sick leave and inability to work due to back pain each year. In the United States it is 3 million years old.

Example USA

Back pain leads to 2.6 million emergency visits every year in the United States, where a high number of opiates are prescribed. The scientists refer to a study from 2009 that found that opioids were prescribed for back pain in about 60 percent of emergency room visits in the United States. Only about half of people with chronic back pain were treated with the help of sports activities.

Pain relievers have a limited effect

"In many countries, pain relievers that have limited positive effects are routinely prescribed for lower back pain," reports Foster. The focus of this treatment must be on targeted exercises.

Lower back pain

"In the UK, we know that low back pain is very common," says Foster. A total of eleven percent of all disabilities are due to back pain. In the past two decades, there has been a twelve percent increase in disability related to back pain. So the problem is getting worse and worse with the aging of the population.

Current treatment approaches are inefficient

"Our current treatment approaches are unable to reduce the back pain burden," said Professor Martin Underwood of Warwick University, commenting on the study results. The way we treat back pain needs to be changed.

Who suffers from back pain?

Adults of working age are often affected by back pain. A specific cause can only be identified in rare cases. Most cases are said to be unspecific. According to the researchers, there are indications that psychological and economic factors play an important role in the persistence of low back pain.

Better education

The authors advise that health systems should avoid harmful and useless treatments for back pain. Widespread misunderstandings about the causes, the prognosis and the effectiveness of various treatments for back pain in the population and among professionals in the health sector should also be clarified.

Researchers call for government support

"Protecting the public from unproven or harmful approaches to relieving back pain requires governments and health care leaders to tackle deadlocked and counter-productive strategies, stakeholders, and financial and professional incentives that maintain the status quo," said study author Professor Jan Hartvigsen von der University of Southern Denmark. (vb)

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