Back pain treatment stretching norms

G.S. Mudur Mar 21, 2018, New Delhi: Many patients with low back pain in India and other countries are prescribed unnecessary imaging scans, medications and bed rest against standard treatment guidelines, a global study released on Wednesday has said.

The study by health researchers in multiple countries found that low back pain is the leading cause of disability worldwide, but diagnosis and treatment are marked by liberal use of imaging, opioids and spinal injections, not in line with best practices.

The best practice guidelines recommend advice to keep active and remain at work. But a survey from India cited by the study found that 46 per cent of physiotherapists in the country had advised patients with low back pain to rest.

About 63 per cent Indians misleadingly believe bed rest is the mainstay of therapy for low back pain, the study said, citing another research study from the country.

The guidelines recommend that imaging through scans should be prescribed for low back pain only when doctors suspect a specific condition that would require a change in treatment. But a three-year study from an Indian orthopaedic clinic found that 100 per cent patients, among whom 76 per cent had non-specific low back pain, underwent imaging.

The study, published in the journal Lancet, also cited earlier research showing patients in Australia, Qatar, South Africa and the US among other countries receiving inappropriate diagnostic or treatment advice.

"In many countries, pain killers 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," Nadine Foster, a study co-author at Keele University in the UK, said in a media release from the journal.

"As lower-income countries respond to this rising cause of disability, it is critical that they avoid the waste that these misguided practices entail."