Global burden of low back pain – a consequence of medical negligence and misinformation
A series of groundbreaking papers from Australian and international researchers in The Lancet, published today, warns that low back pain is a major health burden globally – across developed and developing nations – and that the current use of X-rays and scans, opioids, injections and surgery to investigate and treat the condition is useless, unnecessary and harmful.
Details of The Lancet findings will be announced to coincide with the official launch of the NHMRC Centre for Research Excellence for the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network, to be run by Monash University, at the Cabrini Institute in Melbourne by the Federal Health Minister, Mr Greg Hunt.
Low back pain is the leading cause of disability globally – with more than 540 million people affected by activity-limiting low back pain at any one time. The burden from low back pain has doubled in the last 25 years, and the prevalence of the condition is expected to continue to increase with an aging and increasingly obese population.
Lead researcher of one of the three Lancet papers, Monash University researcher, Professor Rachelle Buchbinder said: “The burden from low back pain has reached a tipping point where the condition is growing rapidly, is poorly understood and is being mismanaged medically – at cost both to the patient and to the healthcare system. Low- and middle- income countries are already emulating the low-value care that is endemic in high-income countries”.
The other Australian lead authors are Professor Chris Maher, Associate Prof Manuela Ferreira and Professor Paulo Ferreira from The University of Sydney and Associate Prof Mark Hancock from Macquarie University. The international team behind the series also come from the UK, the US, Denmark, The Netherlands, Canada, Switzerland, Finland, Sweden, Brazil, South Africa and Germany.
Two of the three papers outline the breadth and impact of low back pain globally, how medical care is making the problem worse in both developed and developing countries, and promising solutions that need testing. According to Professor Maher, there is room for hope, however.
“There are safe effective treatments for low back pain; the challenge is ensuring patients get the right care at the right time,” he said.
“A better understanding of low back pain, and changes to the way care for low back pain is delivered and reimbursed, are key to reversing the problems we see now.”
The final paper in the series, by Professor Buchbinder, is a Worldwide Urgent Global Call to Action.
The Call to Action seeks:
- Coordinated inter/national leadership to drive transformational change across health and social services and occupational settings to stop fragmented and outdated models of care
- Development of evidence-based medical responses to low back pain, emphasising the concept of ‘positive health’ – the ability to adapt and self-manage in the face of social, physical and emotional challenges
- Avoidance of what the authors call harmful and useless medical treatments through the adoption of a similar framework to drug regulation – i.e. only include them in public reimbursement packages if proven safe, effective and cost-effective. “Across the globe (there is) inappropriately high use of imaging, rest, opioids, spinal injections and surgery. Doing more of the same will not reduce low back pain disability nor its long term consequences.”
- Public health campaigns to address the widespread population and health professional misconceptions about the causes and prognosis of low back pain and the effectiveness of different treatments
- Funding to support intensified research efforts that test promising solutions to the problem of low-value care and address fundamental gaps in our understanding of how to prevent low back pain, and how best to manage low back pain in low- and middle- income countries.
The NHMRC Centre of Research Excellence for the ANZMUSC Clinical Trial Network, with hubs in both Sydney and Melbourne, is a collaboration of more than 200 clinician-researchers from 21 universities, 21 hospitals and 10 research institutes. Led by Monash University’s Professor Rachelle Buchbinder, the aim of ANZMUSC is to optimise musculoskeletal health by addressing the “paucity of high-quality research that has been focused on arthritis and musculoskeletal conditions, despite these conditions affecting 28% of Australians,” she said.