The hard truth about back pain: don’t are dependent upon drugs, scans or quick fixes | Ann Robinson

The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson

Most treatment is wasteful, wanton and wrong, says the Lancet. The key is to try to keep walking and working, says the GP Ann Robinson

The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson

Back pain is the biggest cause of disability globally, and most of us will have at least one nasty bout of it. But treatment is often wasteful, wanton and wrong,according to a series of papers in the Lancet.” Worldwide, overuse of inappropriate tests and treatments such as imaging, opioids and surgery means patients are not receiving the right care, and resources are wasted ,” it says.

It’s perfectly understandable to want a quick-fix solution to make the pain go away and maybe a scan to set your mind at rest. But there isn’t a reliable instant answer. Scans don’t attain you better, and painkillers can be harmful. The vast majority of low back pain is musculoskeletal– caused by damage to ligaments, joints and muscles surrounding the spine. A tiny percentage is due to a serious or dangerous underlying cause that needs specific diagnosis and intervention- such as cancer, infection or a fracture.

An underlying cause is more likely if you have so-called red-flag symptoms; previous or current diagnosis of cancer, fever, unexplained weight loss and sweats, night pain, pain in the middle of your back rather than lower, inability to stand, urinate or open your bowels, or severe and unremitting pain that is getting worse.

The good news is that if your backache is musculoskeletal- and it usually is- 90% of cases will be better within six weeks. And that is irrespective of what you do. There’s no good evidence that interventions, ranging from Tens machines( which employ a mild electric current ), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly affect the outcome. Prolonged bed rest- still advocated in some countries- is positively dangerous, as it can cause blood clotting( thrombosis) and attains recovery from back pain less likely.

‘The - The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson
‘ The evidence may not be great but it’s cheap, safe and happens to work for me .’ A Tens machine. Photograph: Alamy Stock Photo

It’s tempting to want a scan or special investigations if you develop back pain. But scans don’t correlate well with symptoms; you can have a dire-looking scan with no symptoms or a reasonably normal-looking one with dreadful ache. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back pain is associated with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.

The key to recovery is to try to keep walking and working. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s cheap, safe, and happens to work for me.

Painkillers can be useful in the short term, if that’s the only way you can keep moving. There are two main groups of effective analgesics, and they both come with health warnings: non-steroidal anti-inflammatories, ( NSAID ) such as ibuprofen, and opioids such as tramadol. There is already an epidemic of opioid overuse and craving in the US, with Europe and lower-income countries catching up fast. NSAIDs are less addictive but can cause heart, kidney and intestine injury if used for more than a few days at a time.

Prof Nadine Foster of Keele University, one of the authors of this series of papers, says:” In many countries, painkillers that have limited positive effect are routinely prescribed for low back ache, with very little emphasis on interventions that are evidence-based, such as exercisings. As lower-income countries respond to this rapidly rising cause of disability, it is critical that they avoid the waste that these misguided practises necessitate .”

One in three people who has an episode of low back ache will have a recurrence in the subsequent year. So it is important to look at adaptations to the workplace, avoiding heavy lifting and concentrate on core muscle strengthening with pilates, swimming and some types of yoga once you recover from the acute attack.

Prof Jan Hartvigsen, of the University of Southern Denmark, who also contributed to the Lancet series, says:” 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 interest, and fiscal and professional incentives that maintain the status quo … Funders should pay only for high-value care, stop funding ineffective or harmful tests and treatments, and importantly intensify research into prevention, better tests and better treatments .”

He’s right, of course, but there is no point withdrawing money without any explanation. Healthcare professionals need to take the time to explain to patients that it’s not vindictive cost-cutting that is behind the restriction of access to scans and drugs. It’s in everyone’s best interests that we stop pursuing bad medication and invest in finding better and safer solutions to this global problem, which is likely to affect all of us sooner or later.

* Ann Robinson is a GP

Read more: www.theguardian.com

The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson
The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson
The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson
The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson
The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson

The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson

The Hard Truth About Back Pain: Don't Are Dependent Upon Drugs, Scans Or Quick Fixes | Ann Robinson

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