Most treatment is wasteful, wanton and wrong, says the Lancet. The key is to try to keep walking and working, says the GP Ann Robinson
Back pain is the biggest cause of disability globally, and most of us will have at least one nasty bout of it. But treatment is often wasteful, wanton and wrong, according to a series of papers in the Lancet . Worldwide, overuse of inappropriate tests and treatments such as imaging, opioids and surgery means patients are not receiving the right care, and resources are wasted, it says.
Its perfectly understandable to want a quick-fix solution to make the pain go away and maybe a scan to set your mind at rest. But there isnt a reliable instant solution. Scans dont make you better, and painkillers can be harmful. The vast majority of low back pain is musculoskeletal caused by damage to ligaments, joints and muscles surrounding the spine. A tiny percentage is due to a serious or dangerous underlying cause that needs specific diagnosis and intervention such as cancer, infection or a fracture.
An underlying cause is more likely if you have so-called red-flag symptoms; previous or current diagnosis of cancer, fever, unexplained weight loss and sweats, night pain, pain in the middle of your back rather than lower, inability to stand, urinate or open your bowels, or severe and unremitting pain that is getting worse.
The good news is that if your backache is musculoskeletal and it usually is 90% of cases will be better within six weeks. And that is irrespective of what you do. Theres no good evidence that interventions, ranging from Tens machines (which use a mild electric current), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly affect the outcome. Prolonged bed rest still advocated in some countries is positively dangerous, as it can cause blood clotting (thrombosis) and makes recovery from back pain less likely.