WEDNESDAY, March 21, 2018 -- Low back pain affects 540 million people worldwide and is the leading cause of disability, but it's often treated improperly, researchers report.
Their review of evidence from around the world suggests low back pain should be managed in primary care and that the first step should be education and urging patients to stay active and working.
But inappropriate tests and treatments are common. Many patients are treated in emergency rooms, told to take time off from work and rest, referred for scans or surgery, and prescribed painkillers that include addictive opioids, the researchers said.
The findings appear in a new series of papers published March 21 in The Lancet medical journal.
"The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work," series co-author Rachelle Buchbinder said in a journal news release. She is a professor of epidemiology and preventive medicine at Monash University in Victoria, Australia.
"Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed," Buchbinder said.
In the United States, low back pain leads to 2.6 million emergency room visits each year. A 2009 study reported that opioids were prescribed in about 60 percent of such cases.
Only about half of Americans with chronic back pain are prescribed exercise, the series reported.
"In many countries, painkillers that have limited positive effect are routinely prescribed for low back pain, with very little emphasis on interventions that are evidence based such as exercises," said study co-author author Nadine Foster.
She is a professor of musculoskeletal health in primary care at Keele University in England.
A study last year reported low back pain as the leading cause of disability in almost all high-income countries, as well as in central and eastern Europe, North Africa and the Middle East, and parts of Latin America.
Worldwide, disability from chronic back pain has risen more than 50 percent since 1990, and the trend is expected to continue as the number of seniors grows.
Low back pain mostly affects working-age adults and a specific cause is rarely pinpointed.
Though most cases are short-lived, about a third of patients have a repeat episode of low back pain within a year. The researchers said it is increasingly viewed as a long-lasting condition.
They said patients and health professionals need to be educated about the causes and outcomes of low back pain, as well as the effectiveness of different treatments.
"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 interests, and financial and professional incentives that maintain the status quo," said study co-author Jan Hartvigsen.
He heads the research unit for clinical biomechanics at the University of Southern Denmark in Odense.
The U.S. National Institute of Neurological Disorders and Stroke has more on low back pain.
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