Most Treatment for Back Pain is Wrong

Dr. Michele Maiers for NWHSU | May 18, 2018

Dr. Michele Maiers, Executive Director of Research & Innovation at Northwestern Health Sciences University discusses recent findings on low back pain and treatment.

A landmark series on low back pain was recently published by The Lancet. The product of a multi-year collaboration among a wide range of researchers and back pain experts, these papers achieve two very important things. First, they raise awareness of back pain as a serious public health issue. Back pain is the leading cause of years lived with disability in the US and world-wide; disability due to back pain has increased by more than 50% since 1990. Second, they boldly call to task the healthcare community, asserting that the majority of care for back pain is unnecessary, ineffective, or results in more harm than good (the overutilization of opioids in the US serving as a prime example of the latter).

Key clinical pearls to take away from the series:

  1. The most important advice for someone with back pain is to stay active. Back pain sufferers should exercise, keep moving, remain at work and engage in normal daily activities as they are able.
  2. If care is needed, best practice guidelines recommend spinal manipulation (like that provided by chiropractors), acupuncture and massage as first line treatments. If there is a strong patient preference for medications, over-the-counter NSAIDs are recommended. Prescription medications and more invasive therapies are only recommended if conservative care has been unsuccessful.

The authors make a clear and compelling case for change within the healthcare system, elevating the importance of complementary and integrative care providers in spine care pathways:

“Crucial to changing behaviour and improving delivery of effective care are system changes that integrate and support health professionals from diverse disciplines and care settings.” (Buchbinder 2018)

Importantly, they suggest the management of back pain has been over-medicalized with high-tech diagnostic procedures and interventions. Self-care measures and non-drug treatments have been shown by research to be both lower-risk, and more effective:

“Greater emphasis is now placed on self-management, physical and psychological therapies, and some forms of complementary medicine, and less emphasis on pharmacological and surgical treatments.” (Foster 2018)

With widespread international exposure in the popular press, on social media, and within healthcare circles, the low back pain series in The Lancet is sure to be an important resource for healthcare policy and practice reform. An audio interview with the series’ lead authors (including Jan Hartvigsen, DC, PhD) is available online.


Watch Dr. Michele Maiers talk more about the burden of low back pain here.

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