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The prevalence and treatment of LBP: the evidence, the challenges and promising directions

Date Posted:22/05/2018
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Publication:

The Lancet, 22nd March 2018

Authors:

Jan Hartvigsen, Mark J Hancock, Alice Kongsted, Quinette Louw, Manuela L Ferreira, Stéphane Genevay, Damian Hoy, Jaro Karppinen, Glenn Pransky, Joachim Sieper, Rob J Smeets, Martin Underwood

Nadine E Foster, Johannes R Anema, Dan Cherkin, Roger Chou, Steven P Cohen, Douglas P Gross, Paulo H Ferreira, Julie M Fritz, Bart W Koes, Wilco Peul, Judith A Turner, Chris G Maher

Rachelle Buchbinder, Maurits van Tulder, Birgitta Öberg, Lucíola Menezes Costa, Anthony Woolf, Mark Schoene, Peter Croft

Introduction

Low back pain affects 540 million people Worldwide at any one time
Low back pain mostly affects people of working age
In the UK, low back pain accounts for 11% of the entire disability budget
In the UK, there has been a 12% increase in disability due to low back pain in the last 2 decades and a 50% increase since 1990
Too many people are receiving the wrong treatment
There is an overuse of inappropriate tests and treatments, such as imaging, opioids and surgery
Some low back pain conditions resolve, 1/3 people have a recurrence within a year of the first episode.  It is no understood that low back pain is a long-term condition

The purpose of the study

The purpose of this study was to investigate the gap between the best available evidence and practice in low back pain conditions.

Outcomes of the study

The study showed that low back pain is mistreated, often against the best practice treatment guidelines and that there is a need to reduce the gap between evidence and practice in low back pain conditions.

The authors says that there is a need to address widespread misconceptions in the population and among health professionals about the causes, prognosis and effectiveness of different treatments for low back pain.

Series author Professor Jan Hartvigsen, University of Southern Denmark comments:

“Millions of people across the world are getting the wrong care for low back pain. Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo.”

 

Conclusions

IMAGING

Such as x-ray or MRI has a very limited role in LBP cases.

FIRST LINE OF ACTION:

Self-management and resuming of normal activities and exercise, limited use of medications.
Advice and education about LBP reassurance
Bed rest avoidance
Consider CBT and stress reduction techniques

NON-RESPONSIVE TO SELF-MANAGEMENT AND SYMPTOMS LASTING MORE THAN 12 WEEKS

Often recommended in the literature: course of spinal manipulation, massage and acupuncture
Supervised, tailored exercise based on ability of the patient
Consider CBT therapy and stress reduction techniques
Paracetomol is not recommended, but prescription NSAIDs might help in conjunction with other therapies.

Other medications should only be used when other methods have not worked)

SURGERY

There is very little evidence that surgeries, such as discectomy, laminectomy and spinal fusion are effective

 

Glossary of terms

CBT: cognitive behaviour psychotherapy – a therapy where a person is given tailored strategies so that they can help themselves with any emotional trauma

Imaging: for example, CT scans, X-ray and MRI

Prevalence: how common something is

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