Changing Approaches Towards Lower Back Pain

With recent changes to the major international guidelines for the management of lower back pain general practitioners are now most likely not to recommend pain medicines that used to be the go to treatment. Now general practitioners might recommend non-medical approaches such as mindfulness, yoga, and other various types of psychological and physiotherapy therapies.

The new guidelines encourage a shift in the primary care management of lower back pain in response to the growing addiction to prescription opioids crisis, and to an overwhelming amount of data collected from research showing that most pain medicines have very little to no effect when compared to placebos for people with lower back pain.

The University of Sydney investigated current approaches and changes to diagnosis and care of lower back pain, with the findings being published in the Canadian Medical Association Journal.

Discouragement of other invasive treatments including surgery and injections and avoidance of pain medicines initially is suggested in these new recommended guidelines. The previous recommendations were in places for decades, these changes are important and represent substantial change in the thinking of how best to treat lower back pain.

A case of uncomplicated or recent onset of lower back pain may now be suggested to remain active using non-drug methods for relief such as massage and heat with follow up to check on progress in a few weeks. If not a new case it might be suggested to try such treatments as exercise or yoga, with other options such as acupuncture, spinal manipulation, or multidisciplinary rehabilitation programs.

There are real concerns that without support from Medicare the suggested reforms may place an additional financial strain on those suffering with lower back pain. It is currently much cheaper and easier to provide prescriptions for opioid pain medicines, which are not a long term solution and carry risk of addiction and harm, than it is to undergo a course of treatment with a psychologist or physiotherapist. Health systems in most countries are not always set up to fund the care that is most appropriate course of action currently. Without policy changes it will be a challenge for doctors to follow the suggested current best practice. If Medicare were to make the changes needed to improve the affordability of alternatives to pain medicines it would result in a major impact on the lives of people with lower back pain, including those now relying on opioids. This is definitely something worthy of needing the attention of the Federal Government.