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Many doctors ignore guidelines in treating lower back pain, put patients at risk

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Study underscores the need for better pain management.

If you suffer from lower back pain, there’s a good chance you’ll wind up in the doctor’s office. Up to 45 percent of us have the problem every year.

However, new research indicates that only about half of primary care doctors follow best practice guidelines in treating the condition. The rest ignore these optimum standards altogether, and the authors conclude the guideline deviations are “potentially harmful.”

Guidelines are there for a reason, and the new research confirms that doctors who aren’t pain management specialists may be over treating patients in many cases or providing care that’s inappropriate.

The study, “Management of Low Back Pain in General Practice—Is it of Acceptable Quality” was recently published in the journal BMC Family Practice. It reviewed the treatment approaches of 25 Italian general practitioners who cared for 475 patients complaining of lower back pain and a variety of related conditions.

Over a four-week period the doctors were asked to monitor the patients progress on questionnaires from initial diagnosis through treatment and referrals to specialty care. To measure how well the doctors stuck to established protocols, the researchers devised their own analysis tool, which combined local practices with those from other countries.

Among the quality measures, no more than 10 percent of lower back pain patients should undergo an x-ray on their first doctor visit and at least 30 percent with back pain and a more painful condition called sciatica should get an anti-inflammatory drug alone or with a prescription painkiller.

However, more than 14.3 percent of patients with lower back pain and 16.7 percent of those with sciatica were referred to x-ray at their first appointment and only a few doctors recommended an anti-inflammatory as a first option.

“Our study reveals gross deviations of [primary care] management of [lower back pain] from current guidelines,” conclude the authors. The net is result is a tendency to over diagnose with scanning devices, or over treat with anti-inflammatories in many some cases, as well as use an obsolete form of pain injections.

“All three deviations are potentially harmful,” say the authors. While they concede their study is a small one and it’s often harder to get specialty care in Italy than in the US, “our results hardly draw a picture of perfect [primary care doctors] happily following guidelines.” In fact, they may be going off course even more than the findings suggest.

The researchers point out that pain is a complex condition and not just the result of an injury. Doctors need to recognize the emotional as well as physical aspects of the problem. In cases of chronic pain, referral to a pain management specialist opens the door to the best treatments based on what really works.

Study from BMC Family Practice, 10/04/2013

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