Back pain treatment challenged

Researchers are calling for a review of clinical guidelines for treating acute low back pain following a study published in JAMA Neurology.

The study shows that early, specialised care, which is recommended in global guidelines, does nothing to help a patient’s recovery.

In a randomised, placebo-controlled trial for testing the effectiveness of early, specialised patient education for acute low back pain, Neuroscience Research Australia Associate Professor James McAuley, co-author of the study, says recommendations to include intensive early management in treatment for acute low back pain may be premature.

“Most people recover from acute low back pain without medical intervention,” he said. “In our study, we were interested in treating those who were at risk of not recovering.

“Globally, major clinical guidelines recommend that health practitioners provide patient education to manage acute low back pain. This is the treatment for back pain that is currently the most accepted and recommended.”

The University of Sydney’s Dr Adrian Traeger, lead-author of the study, said: “The guidelines have also recently started saying that rather than give minimal care, such as advice and reassurance, health practitioners should refer for early specialised care over multiple sessions if they identify a patient as being at high risk of developing chronic pain.

“Our study is the first to actually test this approach against a placebo and our results suggest that the recommendations were premature.”

The study followed 202 participants in Sydney who had experienced low back pain for less than six weeks and showed a high risk of developing chronic low back pain. All participants also saw their regular health practitioner during this study.

Participants in the intervention group received early, specialised care involving patient education over two one-hour sessions. The education focused on pain and contributing factors and self-management techniques. Participants in the control group received placebo patient education – active listening without information or advice.

“These results challenge a widespread belief that patient education is an effective strategy for treatment of acute low back pain,” Mr McAuley said.

“Adding specialised, time-consuming treatment to primary care is unnecessary for most patients with acute low back pain. This has the potential to fundamentally change the way acute low back pain is managed in primary ca