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Low back pain named as leading cause of disability

Patients frequently receive the wrong kind of care, says report

Low back pain has been named the leading cause of disability worldwide as experts accused doctors and policymakers of letting down patients with the condition.

At any one time, 540 million people globally are affected by pain in the lower back that can be crippling and persist for months or even years.

Most cases respond to simple physical and psychological therapies aimed at keeping people active and able to stay at work, according to the authors of a major series of studies.

Our current treatment approaches are failing to reduce the burden of back pain disability. Professor Martin Underwood

Instead many back pain sufferers are wrongly being treated in hospital emergency departments, referred for scans or surgery, encouraged to rest and stop work, and prescribed powerful opioid pain killers, it is claimed.

In the UK, which has up-to-date guidelines supporting the use of exercise, massage and other non-medical treatments, low back pain accounted for 11% of the total disability burden from all diseases, the research showed.

Each year, one million years of productive life was lost in the UK as a result of the condition.

Professor Martin Underwood, from the University of Warwick, a member of the international team whose findings appear in The Lancet medical journal, said: “Our current treatment approaches are failing to reduce the burden of back pain disability.

“We need to change the way we approach back pain treatment in the UK and help low and middle income countries to avoid developing high cost services of limited effectiveness.”

Steve Tolan, head of practice at the Chartered Society of Physiotherapy, said: “That so many people start out with minor back pain and go on to suffer life-changing consequences is bad enough. That healthcare professionals contribute to that journey is unconscionable.”

The researchers reviewed evidence from both high and low income countries around the world to build up a global picture of the size of the back pain problem and how it was being managed.

They concluded that low back pain was the world’s leading cause of disability but was often treated using aggressive approaches that had been shown not to work.

Author Professor Jan Hartvigsen, from the University of Southern Denmark, said: “Millions of people across the world are getting the wrong care for low back pain.

We need to redirect funding away from ineffective or harmful tests and treatments and towards approaches that promote physical activity and function. Professor Nadine Foster

“Protection for the public from unproven or harmful approaches for managing low back pain require that governments and healthcare leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo.”

Data from the UK showed that in 2006, one in seven of all recorded GP consultations were for musculo-skeletal problems, with back pain being the most common.

Low back pain was the leading cause of years lived with disability in the UK in both 1990 and 2010. Between those two years, the burden increased by 12%.

Professor Nadine Foster, another author from Keele University, said: “The gap between best practice in low back pain must be reduced. We need to redirect funding away from ineffective or harmful tests and treatments and towards approaches that promote physical activity and function.”

Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said low back pain was a cause of misery for a “huge and growing number of patients” across the UK.

She added: “What is clear is that one size does not fit all in terms of managing the pain.

“It’s important that any treatment plan is developed in conversation with the patient, tailored to their needs, taking into account the many different factors that might be impacting on their health.

“GPs will also be mindful of clinical guidelines, such as Nice (National Institute for Health and Care Excellence) guidelines in England, which currently advocate an approach that combines physical, psychological and pharmacological treatments.”

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