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Are You Getting Evidence-based Back Pain Treatment?

Medical Records & StethoscopeA lot of people are confused about what to do when confronted with an episode of low back pain. Unfortunately, that confusion also extends into the healthcare system, such that some patients don’t get effective, evidence-based back pain treatment.

As scientists find the most effective treatments for spine problems, other researchers aggregate that information to form clinical practice guidelines. Clinical practice guidelines for the treatment of acute mechanical low back pain are based upon sound scientific evidence rather than on consensus.

The recommended guidelines for evidence based back pain treatment:

  1. Avoid narcotic pain medication
  2. Avoid passive treatments (such as bed rest, heat, or back braces)
  3. Pursue an aerobic exercise program
  4. Use of a short course of non-steroidal anti-inflammatory drugs (Tylenol, Advil) unless medically contraindicated
  5. Use lumbar spine manipulation therapy (chiropractic manipulation)
  6. Receive education and reassurance about low back pain

So a study in 2010 published in The Spine Journal analyzed the treatment of 92 patients with new onset low back pain. Half of the patients were treated via “usual care” at a major hospital system and failed to receive treatment consistent with evidence-based guidelines. (see table below)

Frequencies of use of reported treatment

The other half of the patient group received evidence-based treatment including exercise, anti-inflammatory medication (NSAIDs), reassurance, and manipulation.  Compared to the “usual care” group, those receiving the evidence-based treatment including chiropractic spinal manipulation therapy had significantly greater improvement in low back function 8, 16, and 24 weeks later.

Commenting on the study, the journal editors wrote, “This study offers some insight into high rates of opioid in passive methods for acute low back pain employed in “usual care” at a university-based hospital. The results of avoiding some well-documented treatment pitfalls and using the evidence-based guideline method appear promising. The study also provides evidence that the actual implementation of guideline recommendations may be truly beneficial to patients, themselves, and not just to payers’ strategy to minimize costs.”

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