Physical therapists join call to stop ‘ineffective and damaging’ low back pain treatment

A major study on low back pain has resulted in calls to stop harmful treatment practices, and a worldwide recognition of disability arising from the condition.

The series of papers, published in the Lancet, asks the medical profession to stop ineffective and potentially damaging treatments such as the prescription of strong drugs and opioids, injections, and unnecessary surgery.

Physical therapists have joined the call to further develop evidence-based treatments in countries across the globe, asserting that patients are better-served by advice that enables active lifestyles rather than high-cost ineffective treatments.

“The authors do not simply focus on high-income countries, but highlight gaps in evidence across high, middle and low-income countries,” says WCPT President Emma Stokes.

“Noticeable gaps exist between the research findings and practice. This is a complex scenario where we need to understand and propose multifarious solutions, recognising that one size does not fit all when it comes to knowledge translation strategies. A global effort will take time and determination.”

Low back pain can affect people of all ages, often with unclear causes. Its prevalence is increasing, with disability due to back pain rising by 50% since 1990. The new research recognises the complexity of the condition, while emphasising the scarcity of evidence on back pain prevention.

“There are lots of things that can be done,” says Professor Nadine Foster, co-author of the second paper in the series, Prevention and treatment of low back pain: evidence, challenges, and promising directions.

“These include, where possible, patients self-managing symptoms, and insisting that healthcare practitioners provide evidence-based treatments. Healthcare professionals, including physical therapists and professional bodies, can ensure that training and CPD is evidence-based.”

The emphasis on physical activity and evidence is echoed by Dr Ken Olson, President of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT).

“Early advanced imaging and overuse of opioids are cited as contributing to the worsening of the low back pain problem,” he says.

“But education around staying active, returning patients to work, specific exercises, and – if symptoms persist – spinal manipulation are supported by the evidence, and are provided effectively by physical therapists.”

The series concludes by calling on the World Health Organisation (WHO) to increase attention on the burden created by low back pain, asking international leaders and research funders to focus on prevention while making the condition a global research priority.

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