Self-Care in Low Back Pain: Ineffective as a Stand-Alone Treatment

May 22, 2015 in Our News & Bulletins by Primary Spine & Rehab

Nonspecific low back pain (LBP) ranks as one of the most common and costly musculoskeletal disorders. Despite a strong focus on the problem for decades, healthcare spending on this problem continues to rise. The majority of costs related to low back pain are not from the initial complaint. The majority of costs stem from chronicity and recurrence. A potential explanation of the large treatment costs is that there is a tendency in the healthcare profession to help patients seek immediate pain relief through largely passive treatments and then declare the back pain resolved when there has been a week of no pain.(1-4) When low back pain recurs, patients return for further treatment initiating what some have qualified as a process of dependence.(5) The problem with this approach is that most cases of non-specific low back pain are not a pain syndrome and not a specific injury. They are a deconditioning syndrome, where normal wear and tear on the back occasionally overcomes the body’s capacity to cope with daily stresses, and an episode of pain flares up.

 

One solution sometimes proposed in practice guidelines is to teach patients “self-treatment.”  In short, this means teaching people some exercises, stretches, and behaviors to remedy back pain and sending them home to give it a try. In principal, this sounds great. It is an active treatment that can improve the condition of a person’s back; it empowers people to be in charge of their own wellness; and it costs little. Unfortunately, research has found one, big problem with the idea of self-treatment in professional health care. It usually doesn’t work. Or at least, it doesn’t work enough to matter.

 

This was demonstrated recently in a systematic review and meta-analysis published in Arthritis Care & Research.  They included 13 randomized, controlled trials covering 3,063 people with back pain. In the various trials, self-care techniques were taught by means of personal demonstration, videos, manuals, and websites. In final analysis, the long-term effect of self-care was a 4.8 point improvement on a 100-point scale. The authors of the review describe the effect as “small” and “trivial.”

 

This by no means suggests that people should not include behaviors, exercises, and stretches for back health into their normal routines. What this study suggests is that for that subset of people who have back pain so distracting that they visit a healthcare professional, sending them home with some advice is not enough.

 

The other problem with self-care is that it becomes a wait-and-see approach. Wait-and-see can be counterproductive, because research suggests physical therapy can be most effective when care begins shortly after a back pain flare up. In fact, research shows that when physical therapy begins within 14 days of a primary care consult for back pain, these benefits accrue: (1-2)

  • Medical costs reduced by $3,058 per patient
  • Use of advanced imaging reduced by 74%
  • Need for surgery reduced by 55%
  • Need for injections reduced by 58%
  • Use of opioids reduced by 22%

 

If you wrestle with back pain, give us a call.

 

References

  1. Fritz J, Childs J, Wainner R, Flynn T. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.  Spine. 2012; 37 (25): 2114-21.
  2. Gelhorn A, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine. 2012; 37 (9): 775-782.
  3. Machado L, Kamper S, Herbert R, et al. Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology (Oxford). 2009; 48: 520-7.
  4. Costa L, Maher C, McAuley J, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ. 2009; 339: b3829.
  5. Oliveira V, Ferreira P, Maher C, et al. Effectiveness of self-management of low back pain: systematic review with meta-analysis. Arthritis Care & Research. 2012; 64 (11): 1739-1748.

Low Back Pain Self Care

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