Today, a Lancet series of papers on back pain and a new 2.5 million NHMRC Centre for Research Excellence will launch a response to worldwide concern that too many back pain patients are receiving the wrong care, to the detriment of patients and healthcare systems.
Low back pain is the leading cause of disability worldwide, affecting an estimated 540 million people at any one time – and causing more disability than lung, bowel and breast cancer combined.
The burden from low back pain has doubled in the last 25 years, and the prevalence of the condition is expected to continue to increase with an aging and increasingly obese population
Led by a team of Australian and international researchers, the Lancet series published today, highlights the extent to which low back pain is mistreated, often against best practice treatment guidelines.
The series reveals misconceptions about best practice are widespread among healthcare professionals, funders and patients themselves, and that medical guidelines are frequently ignored.
University of Sydney author Professor Chris Maher said millions of people across the world are getting the wrong care for low back pain.
“More care does not mean better care. More aggressive treatments for low back pain have little proven benefit and have the potential to make things significantly worse for patients.
“Evidence suggests that low back pain should be managed in primary care, with the first line of treatment being education and advice to keep active and at work.
“However, in reality, a high proportion of patients worldwide are treated in emergency departments, encouraged to rest and stop work, are commonly referred for scans or surgery, or prescribed pain killers including opioids, which are discouraged for treating low back pain.”
Australian authors of the Lancet series include Professor Chris Maher, Associate Professor Manuela Ferreira and Associate Professor Paulo Ferreira from The University of Sydney; Professor Rachelle Buchbinder from Monash University and Associate Professor Mark Hancock from Macquarie University. The international team behind the series come from the UK, the US, Denmark, the Netherlands, Canada, Switzerland, Finland, Sweden, Brazil, South Africa and Germany.
Associate Professor Manuela Ferreira said health systems currently fund tests and treatments that are unnecessary, ineffective and often harmful such as X-rays, scans, opioids, injections and surgery.
“But they don’t fund interventions that are helpful including physical and psychological therapies for chronic low back pain.”
Associate Professor Paulo Ferreira said: “The series highlights the 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.”
Also announced today, a $2.5 million NHMRC Centre of Research Excellence (CRE) for the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network to be run jointly by Monash University and the University of Sydney.
The CRE, launched by the Federal Health Minister, Hon Greg Hunt MP, will be a collaboration of more than 200 clinician-researchers from 21 universities, 21 hospitals and ten research institutes. The aim of ANZMUSC is to optimise musculoskeletal health by addressing the lack of high quality research that has been focused on arthritis and musculoskeletal conditions, despite these conditions affecting 28 per cent of Australians.
Monash University’s Professor Rachelle Buchbinder said: “The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work.
“Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.
“We need better access to low-tech, cheap recommended approaches to manage low back pain such as patient education and exercise, which need to replace expensive harmful treatments,” she said.
“There is room for hope here,” added Professor Maher.
“There are safe effective treatments for low back pain, the challenge is ensuring patients get the right care at the right time.
“A better understanding of low back pain, and changes to the way care for low back pain is delivered and reimbursed, are key to reversing the problems we see now.”