Millions of people with back pain are being given the wrong treatment, a major review has found.
Many patients are needlessly being prescribed strong painkillers, wrongly told to rest or even undergoing unnecessary surgery in a bid to treat lower back pain.
This is despite mounting evidence showing that simple exercises and stretches are more effective for easing symptoms.
Lower back pain is now the leading cause of disability in the UK, responsible for more than one in 10 of all serious health complaints.
It costs the NHS £2.1 billion annually and is estimated to cost the UK economy around £10 billion in lost working days and informal care.
Many victims of the agonising pain are told to stop work and exercise, prescribed painkillers or undergo surgery
Unnecessary and aggressive interventions
But a series of international studies published in The Lancet medical journal found treatments often go against international guidelines.
Rather than being encouraged to stay active and at work, many NHS patients are being prescribed powerful opioid pain killers, treated in hospital A&Es and referred for scans or surgery.
Professor Martin Underwood, from the University of Warwick, who was part of the international team, warned this was costly to both patients and the health service.
‘Our current treatment approaches are failing to reduce the burden of back pain disability,’ he said.
‘We need to change the way we approach back pain treatment in the UK and help low and middle income countries to avoid developing high cost services of limited effectiveness.’ The researchers reviewed evidence from both high and low income countries around the world to build up a global picture of the size of the back pain problem and how it was being managed.
Our current treatment approaches are failing to reduce the burden of back pain disability
Professor Martin Underwood, from the University of Warwick
They concluded that low back pain was the world’s leading cause of disability but was often treated using aggressive approaches that had been shown not to work.
In Britain NHS watchdog NICE advises that people with back pain are prescribed exercise, drugs such as ibuprofen, or both at the same time.
But growing evidence shows painkillers are largely ineffective and can do more harm than good, with massage, exercise and yoga preferable.
Previous studies have shown opioid painkillers – prescription drugs that include morphine, tramadol and oxycodone – provide only ‘minimal benefit’ for lower back pain.
Yet, recent figures estimate they are still prescribed to around 40 per cent of back pain patients.
Steve Tolan, head of practice at the Chartered Society of Physiotherapy, said doctors were too quick to medicalise treatments.
‘That so many people start out with minor back pain and go on to suffer life-changing consequences is bad enough,’ he said. ‘That healthcare professionals contribute to that journey is unconscionable.’ Official data shows around one in seven GP appointments are taken by patients with musculoskeletal complaints, with back pain topping the list.
‘We really need to redress the balance’
Lower back pain was the leading cause of years lived with disability in the UK in both 1990 and 2010, with the burden rising by 12 percent just 20 years.
Each year, one million years of productive life was lost in the UK as a result of the condition.
It is most prevalent in people of working age and is often short-lived with exercise recommended to both ease symptoms and prevent the pain coming back.
Professor Nadine Foster, from Keele University, said the number of patients suffering from the disability will continue to rise with the population.
‘We know a lot about what to do for back pain – and a lot of what not to do – the problem is that healthcare systems around the world are doing things differently.
‘In many countries, painkillers that have limited positive effect are routinely prescribed for low back pain, with very little emphasis on interventions that are evidence based such as exercises.
‘We really need to redress the balance. Doing more of the same that we’ve been trying to do for the last few decades, is not going to reduce back pain disability.’ Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said low back pain was a cause of misery for a ‘huge and growing number of patients’ across the UK.
‘What is clear is that one size does not fit all in terms of managing the pain,’ she said.
‘It’s important that any treatment plan is developed in conversation with the patient, tailored to their needs, taking into account the many different factors that might be impacting on their health.’
WHAT ARE THE MOST COMMON MYTHS ABOUT BACK PAIN?
You should always rest a bad back: Moderate exercise is essential to build and maintain strength and flexibility in the spine, improving posture and protecting you from any further pain. While total rest may seem like a good way to recover often continuing moderate physical activity will help in the long run. Your local chiropractor will be able to advise on what is right for you.
Back or neck pain is simply part of the ageing process: While ageing can have an impact on your back health, back or neck pain can occur at any age. Maintaining good health into later years and being aware of how to preserve one of our body’s most important assets, the back, is important in allowing us to maintain activity levels. The BCA has advice on how to protect your back at any age.
Back or neck pain is not common: Back and neck pain is very common, and statistics have shown that 80 per cent of people will experience back pain at some point in their lives.
The spine can be injured easily: The spine is actually one of the strongest parts of your body and is designed to be strong. Like any other part of your body though, taking good care of it is essential to allow it to do its job effectively for as long as possible.
A slipped disc means a disc has slipped out of your spine: The discs are circular pads of connective tissue – cartilage – in between each vertebra in your back. These discs have an inner gel-like substance and a tough outer case. They help maintain your back’s flexibility and wide range of movement. A slipped disc means that one of the discs of cartilage in the spine is damaged and possibly extruding, irritating or pressing on the nerves. It can also be known as a prolapsed or herniated disc.
Pain killers can cure back pain: Most back pain is ‘mechanical’ in nature so, even though painkillers can be helpful, some sort of mechanical, hands on treatment involving movement/exercise is more likely to help manage the problem and reduce recurrence.