A team of international health experts has accused the medical fraternity of “mismanaging” back pain and providing “ineffective and harmful” treatments.
In three papers published in the esteemed Lancet medical journal, the Australian and international authors assert that low back pain has increased dramatically in recent years and is now the leading cause of disability globally.
They find there is an over-reliance on scans, surgeries and opioids prescriptions to treat a problem that could be more effectively addressed through self-management and less-invasive physical and psychological therapies.
Monash University researcher, Professor Rachelle Buchbinder, is the lead author of one of the three papers and said a radical shift in thinking was required.
“The burden from low back pain has reached a tipping point where the condition is growing rapidly, is poorly understood and is being mismanaged medically — at cost both to the patient and to the healthcare system,” she said.
“It’s a problem in Australia. A large number of people are receiving low-value care that wastes a lot of money, it’s ineffective and sometimes harmful.
“And at the same time they’re not receiving the evidence-based care that could actually help them.
“Both clinicians and the public have misconceptions that we can identify a cause and therefore we can treat something specific.”
Professor Buchbinder said back pain should not be treated as an “injury”, but as an issue that comes and goes and in many cases can be effectively managed.
A growing issue
The Lancet papers found that globally, years lived with disability caused by low back pain increased by 54 per cent between 1990 and 2015, primarily due to population increase and ageing.
It is estimated 540 million people worldwide are now affected by back pain at any one time, while in Australia more than 3.7 million people experienced this type of pain.
The papers found that an ageing global population, urbanisation, sedentary lifestyles and the emergence of new technologies would likely exacerbate the problem.
Australian back pain expert, Professor Chris Maher, is the lead author of another of the Lancet papers and said a better understanding of the issue was needed.
“There are safe, effective treatments for low back pain; the challenge is ensuring patients get the right care at the right time,” he said.
The paper he co-authored found despite very few cases of back pain constituting a medical emergency, patients in Australia frequently go to the emergency department.
And that while surgery has “at best a very limited role for low back pain”, Australian studies showed frequent use of spinal fusion.
The US is a cautionary tale
Professor Buchbinder’s paper cited the ongoing opioid addiction crisis in the US as a worst-case scenario if the medication-oriented approach to low back pain wasn’t shifted.
“Increased use of ineffective and potentially harmful treatments has wasted limited health care resources and caused harm,” the paper reads.
“The current epidemic of addiction and rising mortality resulting from increased opioid prescribing in the US over the past 20 years provides a dramatic example of the disastrous effects of harmful medical intervention.”
Professor Buchbinder’s paper found that funding for low back pain research was “limited and unco-ordinated” and called for the establishment of a global network of experts to pool their experience and research.
Back pain in Australia
- Australia spends $4.8 billion a year on management of low back pain
- Back pain reduces Australia’s GDP by $3.2 billion a year
- 50 per cent of Australians suffered from back pain in the past month
Source: Monash University