‘ The proof may not be great but it’s inexpensive, safe and happens to work for me .’ A Tens machine. Photograph: Alamy Stock Photo
It’s tempting to want a scan or special investigations if you develop back ache. But scans don’t correlate well with symptoms; you can have a dire-looking scan with no symptoms or a reasonably normal-looking one with dreadful ache. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back pain is associated with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.
The key to recovery is to try to keep walking and operate. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s inexpensive, safe, and happens to work for me.
Painkillers can be useful in the short term, if that’s the only way you can keep moving. There are two main groups of effective painkillers, and they both come with health warnings: non-steroidal anti-inflammatories, ( NSAID ) such as ibuprofen, and opioids such as tramadol. There is already an epidemic of opioid overuse and craving in the US, with Europe and lower-income countries catching up fast. NSAIDs are less addictive but can cause heart, kidney and gut injury if used for more than a few days at a time.
Prof Nadine Foster of Keele University, one of the authors of this series of papers, says:” In many countries, analgesics that have limited positive impacts are routinely prescribed for low back pain, with very little emphasis on interventions that are evidence-based, such as workouts. As lower-income countries respond to this rapidly rising cause of disability, it is critical that they avoid the waste that these misguided practises necessitate .”
One in three people who has an episode of low back pain will have a recurrence in the following year. So it is important to look at adaptations to the workplace, avoiding heavy lifting and concentrate on core muscle strengthening with pilates, swimming and some types of yoga once you recover from the acute attack.
Prof Jan Hartvigsen, of the University of Southern Denmark, who also contributed to the Lancet series, says:” Millions of people across the world are getting the wrong care for low back ache. Protection of the public from unproven or harmful approaches to managing low back ache requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo … Funders should pay merely for high-value care, stop funding ineffective or harmful testing and therapies, and importantly intensify research into prevention, better tests and better therapies .”
He’s right, of course, but there is no phase withdrawing funding without any explain. Healthcare professionals need to take the time to explain to patients that it’s not vindictive cost-cutting that is behind the restriction of access to scans and drugs. It’s in everyone’s best interests that we stop seeking bad medication and invest in discovering better and safer solutions to this global problem, which is likely to affect all of us sooner or later.
* Ann Robinson is a GP