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How do doctors decide what treatment recommendations to make for patients with a first episode of low back pain? I saw a doctor and got no treatment whatsoever. My husband saw the same guy for his backache and suddenly he's getting X-rays, blood work, drugs, and physical therapy. Is there some kind of bias against women or am I being overly sensitive?
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According to a new study from New York University School of Medicine you may not be far off. There has been speculation by many experts about the process used by medical doctors in deciding how to treat acute (early onset or first episodes) of low back pain. This question has been raised again and again because there are now actually clinical practice guidelines (CPGs) to advise physicians on the best known (evidence-based) approach to low back pain.
In the study, the researchers surveyed 284 physicians from five different clinical sites (both primary care physicians and emergency department physicians). They asked questions about physicians' decisions related to patients with low back pain.
Physicians were given a case scenario of a patient with recent onset of low back pain. After giving a written summary of the patient's characteristics, physicians were asked about the diagnostic approach and treatment they might choose for this patient. Analysis of the data took into account the type of treatment recommended based on three factors (sex: male or female, socioeconomic status, and clinical presentation).
Each of these three variables was analyzed based on diagnostic tests physicians would order and the type of treatment recommended. Some of the diagnostic options included blood tests, urinalysis, X-ray, CT scan, MRI, or discography. Of course, no diagnostics was an option, too.
On the treatment side, physicians could recommend no treatment or referral to another physician (specialist), physical therapist, chiropractor, osteopath, or psychologist. Choices of specialists included orthopedic surgeon, physiatrist (physician who specializes in rehabilitation services), neurologist, gynecologist (for women), and anesthesiologist.
For half the physicians, no diagnostics and referral were recommended. Patients were given instructions to stay as active as possible, use heat or cold, and take pain relievers as needed (e.g., ibuprofen or other antiinflammatory). The natural course of the back pain would be explained and an educational pamphlet provided. Almost all physicians recommended a follow-up visit. When referral was recommended, it was most often to a physical therapist.
Of particular interest in the results was the apparent independent link between sex (male versus female) and socioeconomic status (SES) with activity recommendations. It seems physicians were more likely to encourage patients to remain active if they were white-collar workers (higher SES status), especially men. Blue-collar workers (e.g., manual laborers) and women were more likely to be told to take it easy, rest, and restrict heavy lifting or other manual work at home and at work.
The other nonclinical factor that seemed to influence physicians' treatment decisions was the clinical presentation. Patients who expressed distress about their back pain were more likely to be given a prescription for medications. Though not stated, the authors presumed this behavior on the part of physicians was to reduce the patient's suffering.
However, there is no scientific evidence that such treatment is beneficial or yields any better results than doing nothing. And there is plenty of evidence that staying active will improve outcomes.
The authors summarized their findings by saying that this study provided more evidence that for the most part, primary care and emergency department physicians are not treating patients with acute low back pain according to current clinical practice guidelines. Instead, they are being influenced by patient characteristics such as gender (male versus female), socioeconomic status, and complaints of pain, distress, and suffering.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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