More than 540 million people suffer low back pain, the commonest cause of disability in the world. But their condition is often being made worse by costly high-tech interventions and bed rest in what could amount to medical negligence on a global scale.
Large numbers of sufferers across the world are being harmed not healed by invasive surgery, injections and opiates, according to new details published by the Lancet. Prevention is better than cure and what is really needed is better awareness of the dangers of poor posture along with exercise, experts say.
Lower back pain is a significant challenge for patients, health providers and economies across the globe. Each year, almost 1m years of productive life are lost in the United Kingdom due to disability from low back pain, 3m in the US and 300,000 in Australia.
In the UK, the National Health Service has guidance for doctors on non-specific lower back pain that promotes physical exercise and recommends against surgery. However in the US, operations are very common, setting a poor example to the rest of the world. This is a huge problem as there are many high tech, expensive treatments, many of which simply aren't proven to be any benefit.
The NHS does better than the USA with fewer patients being offered expensive fusion surgery, but too many patients are being offered injections that may be of questionable value. Compounding the problem further is their cost to the NHS.
Concerns in the UK are growing about the rising number of opioid painkiller prescriptions handed out. Many trials have shown they are not more effective than other safer drugs, yet patients are routinely still being put on opiate based drugs.
Opiate prescriptions for back pain in the US have fueled a broader opioid crisis. There is a clear epidemic of addiction and a rising mortality resulting from increased opioid prescribing in the USA over the past 20 years. This is a tragic example of the disastrous effects of damaging medical intervention.
The public needs to be protected from “unproven or harmful approaches”, say the experts. Some countries are acting: Australia and the Netherlands are looking at ceasing to pay for some invasive treatments. The experts call for health professionals and patients to adopt what they call a “positive health” approach, defined as “the ability to adapt and to self-manage, in the face of social, physical, and emotional challenges”.
That involves changing beliefs about back pain, so that doctors help patients to live “meaningful, high-quality lives” while people become less likely to expect a diagnosis or a cure.