Researchers say back pain care not consistent with clinical guidelines

General practitioners who treat individuals for low back pain often do so in a manner that isn't consistent with clinical guidelines, according to Australian researchers.

The report, published in the Archives of Internal Medicine, assessed the care provided for new episodes of low back pain during more than 3,500 patient visits to general practitioners between 2001 and 2008. These visits were mapped to key recommendations in treatment guidelines. In addition, researchers said data was compared for two three-year periods before and after the release of the Australian national guidelines in 2004.

Christopher M. Williams, lead author of the study from The George Institute for International Health in Camperdown, Australia, said that with the release of the clinical practice guidelines, it is timely to consider how closely usual care aligns with guideline recommendations. Researchers found that care is not consistent with the recommended guidelines. For example, although guidelines discourage the use of imaging, more than one-quarter of patients were referred for radiology, computed tomography or similar tests.

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In addition, only 20.5 percent of patients received advice and 17.7 percent received simple pain-relieving medications, both of which are recommended as part of initial care for low back pain. Instead of the safer and equally effective acetaminophen, researchers found that patients were more often prescribed non-steroidal anti-inflammatory drugs (37.4 percent) and opioids (19.6 percent).

The study concluded that the views of both patients and clinicians and potentially miscommunication between the two contribute to departures from guideline-based care.

"Understanding why general practitioners do not follow key treatment recommendations of guidelines is an important prerequisite to improving this situation," Williams said.

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April 1, 2010

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