2018, The Lancet Journal’s Review of Low Back Pain

Summary by Academics – Treatment for Low Back Pain 

  • “low back pain according to guidelines should be assessed by looking at the patients body, mind and social support network”
  • “recommendations for early management are advice and education about low back pain as well as reassurance and encouragement to avoid bed rest and reman active including early return to work”
  • “physical treatments, especially for persistent low back pain are gradually increasing activity and exercise programmes that target improvement in function. Some guidelines recommend spinal manipulation and massage as optional or useful as an additional form of therapy”
  • “Guidelines now recommend the use of medication, spinal injections and surgery only after education and physical therapy options have not worked:”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30489-6/fulltext

Three papers were recently published in the Lancet journal https://www.thelancet.com of medicine discussing our current understanding of the burden of disease and treatment practices for low back pain.

WHY Study Low Back Pain ?

Low back pain and spinal problems are the leading cause of disability worldwide. Despite the large number of treatment options, low back complaints are still increasing in high, middle and low income countries. There appear to be gaps between evidence and practice with the limited use of recommended first-line treatments in favour of treatments not supported by evidence.

HOW Can Chiropractic Help ?

Non-specific (unknown cause) low back pain according to guidelines should be assessed by looking at the patients body, mind and social support network. Laboratory tests and imaging such as x-rays should not be routinely used.

Consistent recommendations for early management are advice and education about low back pain as well as reassurance and encouragement to avoid bed rest and reman active including early return to work. Recommended physical treatments, especially for persistent low back pain are gradually increasing activity and exercise programmes that target improvement in function. Some guidelines recommend spinal manipulation and massage as optional or useful as an additional form of therapy.

Guidelines now recommend the use of medication, spinal injections and surgery only after education and physical therapy options have not worked.

WHERE Does Medicine Fit In ?

There is a glaring gap in evidence and practice from all areas of the globe both in low and high income countries. Data from Australia shows that advice and education are provided only in a few consultations and the most common treatment is prescribed medication. One reason for this may be the way the healthcare system preferentially funds surgery and medication over physical and psychological therapies. The authors state that Australia’s medicare system only allows for five Allied Health consultations, which is too few to deliver a typical exercise programme for lower back pain.

SOLUTIONS To Improve Public Health ?

The writers of the paper suggest that better integrated education of health-care professionals may support the use of appropriate first choice low back pain treatments. These include remaining active, manipulation, massage and yoga. An example of this that is cited in the paper is the integrated education of medical doctors and chiropractors.

https://www.thelancet.com/action/doSearch?occurrences=all&searchText=chiropractic&code=lancet-site&searchType=quick&searchScope=fullSite&journalCode=

A summary by Your Waterloo Chiropractor, Sue Tyfield (DC)

 

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