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Routine Back Care Not Always by the Book
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Posted on: 11/30/1999
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When a doctor treats a patient with low back pain, there are two main goals: control pain now, and prevent chronic pain. We know from research that most episodes of back pain go away in six weeks. We also know back pain returns for many people.
Guidelines on assessing and treating back pain are available. National groups put these out after reviewing all the studies on the subject. In the United States, the Agency for Health Care Policy and Research (AHCPR) has issued such guidelines. In Europe the Royal College of General Practitioners has offered similar advice.
How do most doctors handle back pain patients? DO they do it "by the book"? According to this study, doctors in Spain may not be doing such a good job following the guidelines.
The guidelines point out how important the history and exam are in making a correct diagnosis. These steps are initially more important than X-rays or other tests. Yet, in this study, doctors spent less than 10 minutes with each patient. With so little time, they may have gotten important information, but didn't write it down. X-rays weren't used as often as they should be. The guidelines suggest ordering X-rays for back pain in adults over 50 with signs of fracture, infection, or cancer.
Patients are given advice and education, but it may be the wrong kind. Studies show patients get better faster when told back pain usually goes away in a short time no matter what treatment is used. Giving patients advice about what to do works better than talking about anatomy, posture, or giving specific exercises.
These authors conclude that most patients aren't given an exam according to published guidelines. They think if doctors aren't following the guidelines then something must be done to change this practice. Perhaps finding out why some doctors don't follow guidelines will help us change this. Clearly the situation must be improved.
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References:
Violeta González-Urzelai, et al. Routine Primary Care Management of Acute Low Back Pain: Adherence to Clinical Guidelines. In European Spine Journal. December 2003. Vol. 12. No. 6. Pp. 589-594.
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