What is usual care for low back pain? A systematic review of healthcare provided to patients with low back pain in family practice and emergency departments

Review written by Dr Jarod Hall info

Key Points

  1. Recommended first line treatment for patients with low back pain (LBP) includes advice to remain active, and education and reassurance.
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BACKGROUND & OBJECTIVE

Low back pain (LBP) is an extremely common condition with a mean lifetime prevalence of around 40% (1) and is the leading cause of disability globally (2). At an individual level, LBP causes limitations in day to day function, impacts mental health, can result in financial hardship, and reduces quality of life. At a national and global level, direct and indirect costs (estimated to be 100 billion USD in the USA alone (3)) for the care of, and lost productivity related to, LBP have a large impact on medical systems, insurance premiums, and the financial health of society as a whole.

Recommended first-line treatment for patients with LBP includes advice to remain active, and education and reassurance. Adjunctive options include application of heat, manual therapy, non-steroidal anti-inflammatory drugs, and structured exercise and cognitive behavioral therapy for patients with persistent symptoms. Guidelines recommend against imaging unless serious spinal pathology is suspected, and strong analgesics such as opioids should only be prescribed with caution in selected patients.

While these recommendations have been well established over several years, and health providers report being aware of them, there are concerns about substantial gaps between guideline recommendations and the actual care delivered in usual practice. Therefore, the aim of this systematic review was to synthesize evidence about current management of LBP in family practice and emergency departments (ED).

Low back pain is the leading cause of disability globally.
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Usual care for patients with low back pain did not align well with recommendations in clinical practice guidelines.

METHODS

An electronic search was conducted in three databases (EMBASE, PubMed-Medline, and CINAHL) using search terms related to “back pain”, “guideline recommendations”, and “medical records” from inception to May 2019. Studies were included if they:

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