Low back pain continues to be one of the leading causes of disability and burden on healthcare resources worldwide. It is amongst the top three causes of healthcare costs in the USA and accounts for one in six visits to emergency departments in Australia, despite most cases being deemed as non-serious. The new reality of the potential for COVID patients to overwhelm our hospitals in a short space of time has highlighted existing inefficiencies that need to change drastically.
Even with better knowledge around best practice for low back pain treatment over the last decade, low value care such as imaging (Xrays and CT scans), inpatient admission and the use of opioids continues to be the main treatment options for people once they reach hospital. The treatment given will vary considerably by what time of day a patient arrives, their age or how they arrived. Admission to an inpatient ward is twice as likely if a patient arrives during working hours, and three times as likely if they arrive by ambulance and unnecessary imaging is twice as likely to be given to patients aged over 65 years.
Non-serious back pain, formerly known as non-specific back pain, accounts for 95% of back pain episodes. Some of these episodes may involve stress or inflammation to structures such as spinal discs, joints, ligaments and muscles. Pressure on nerves that is due to an inflammatory reaction, rather than a mechanical impingement, also comes under this category and often results in referred, or radicular, pain. Serious back pain is rare. This is usually described as damage to nerves or the spinal cord that may not be reversible unless treated urgently, or tumours and fractures. For non-serious back pain, heavy painkillers such as opioids (codeine, endone etc) have no greater effect than over the counter anti-inflammatories. Opioid use, imaging and hospital admission are strongly associated with poorer outcomes over the short and long-term
So what is best practice or high value care for low back pain? The answers are relatively simple: exercise, weight loss, reduced stress and a healthy diet. Imagine going to hospital and being told that? A large part of the problem lies in our expectations of what treatment should involve and who should administer the treatment. The expectation is often that if you are in pain, a doctor should be able to treat it. The truth is for back pain, it is much easier to prevent in the first place, and the responsibility for that lies with the individual.
As the costs of public health care continue to rise, we all need to take more personal responsibility for our own health if we want to continue to enjoy world-class access to hospital care for serious conditions. So if you are starting to feel a bit of a niggle in your back, get off the recliner, do some exercise, consume less sugars and alcohol and visit your physiotherapist to get you through when you are sore and keep you moving in between.