BACK PAIN A SPINAL TRAP

‘Unnecessary’ interventions impacting patients and health care system

BACK pain is a growing burden affecting more than 250 million people annually, but world-leading experts warn it is mismanaged through overuse of surgery, opioids and scans.

In a series of three papers in prestigious journal The Lancet, international researchers and clinicians, including Australians, raise concerns that “unnecessary” interventions are costing patients and the healthcare system.

They are calling for urgent global action to stop funding unproven treatments for low back pain and switch to those that are effective, safe and economically sound, as well as to bolster research into prevention and treatments.

Lead author of the series of papers, Monash University’s Professor Rachelle Buchbinder, said more than 3.7 million Australians suffered from low back pain with a cost of $9 billion annually.

“It’s the leading cause of disability and needing to retire early and poorer people are disproportionately affected, so it augments the poverty cycle,” Prof Buchbinder said.

In the series of papers published today, the 31 authors — who are physiotherapists, surgeons, general practitioners, chiropractors and rheumatologists — argue most low back pain can be dealt with in primary care with education on how to self-manage the condition and advice on how to stay active and continue to work.

Instead, the authors said many people were treated in emergency departments and given strong painkillers and advised to stop working.

“There are specific causes of low back pain that need specific treatment: cancer, infection and fractures, but the majority of back pain is nonspecific and doesn’t require surgery, opioids or injections,” Prof Buchbinder said.

The Victorian rheumatologist said many of these common treatments did not work and had the potential to cause harm.

She said despite misconceptions in the community, Xrays and scans were often of little benefit because in most cases the specific cause of the pain could not be seen and the results did not change the management of the condition.

Fellow author Professor Jan Hartvigsen from the University of Southern Denmark said millions of people across the world were getting the wrong care for low back pain and governments and healthcare leaders needed to tackle “entrenched and counter-productive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo”.

It comes as Health Minister Greg Hunt launches the Australia and New Zealand Musculoskeletal (ANZMUSC) clinical trials Network in Melbourne today.

More than 200 clinicians and researchers have been funded over five years to consolidate and improve research efforts into low back pain.