The problem
Back pain is something most of us will suffer at some point in our life. The good news is that we now understand a lot about how to effectively manage back pain. Unfortunately it is taking a while for that evidence to reach practice.
Most Australians who self-manage their back pain or seek care from a GP do not receive effective care. Surveys of consumers have shown problems such as use of ineffective treatments and taking sub-optimal doses and types of medicines. For example of the most popular treatments used by respondents to a large Australian population-based survey, half were ineffective or harmful. A large survey of Australian GP care for acute back pain revealed that less than 20% of patients received the care recommended by the NHMRC. This scenario is overwhelmingly similar in many countries around the world despite the striking consensus of back pain guidelines worldwide.
Two likely reasons for this evidence-practice gap are lack of medical training and patient’s expectations/preferences for various tests and treatments. While back pain is the 6th most common condition managed by GPs, back pain and related musculoskeletal conditions receive little attention in medical training and so it is unsurprising that GP’s knowledge on how to manage back pain often conflicts with best available evidence. While the NHMRC recommends a simple approach to managing acute low back pain this often does not align with patients’ expectations. A good example is imaging. Many patients believe that imaging will provide an explanation for their pain and GPs report that they feel pressured to provide such testing even though it has been shown that a strategy of routine imaging does not improve outcomes. However simply ignoring the patient’s expectation for imaging is unwise because patients with a strong preference for imaging often return to the same doctor or seek out a new doctor in order to get imaging.
The solution?
Researchers have studied the problem to death so it was time to do something to fix the problem. The National Prescribing Service (NPS) and the George Institute for Global Health have jointly launched a new decision support tool, Back Pain Choices, to assist primary care clinicians diagnose and manage back pain in line with best practice guidelines.
Back Pain Choices — synthesises recommendations from evidence-based practice guidelines in Australia, the UK and USA into a unified set of recommendations. It also incorporates individual patient preferences for assessments and treatments so by the end of the consultation the patient has an individually tailored management plan and/or information sheet.
Back Pain Choices steps health professionals through the process of examining, diagnosing and treating low back pain. The tool works as a communication mechanism that can be used to engage patients in discussion of low back pain treatment options. By taking this approach, both GPs and patients are made aware of the treatment options available and together they can decide on the most suitable treatment option.
The Back Pain Choices tool is now available free on the NPS website at www.nps.org.au/back-pain-choices.
About Chris Maher
Chris is Professor of Physiotherapy in Sydney Medical School, The University of Sydney and Director of the Musculoskeletal Division at The George Institute for Global Health. He leads a research division focusing on the management of musculoskeletal conditions in primary care and community settings. Prof Maher’s research evaluates the primary care management of back pain and he holds an honorary NHMRC Senior Research Fellowship and an ARC Future Fellowship.
Link to Chris’ published research here