Usual Care for Low Back Pain Doesn’t Align with Guideline Recommendations
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Archives of Internal Medicine article (Free)
Archives of Internal Medicine commentary (Subscription required)
American College of Physicians/American Pain Society guideline on managing low back pain (Free)
General practitioners rarely follow guidelines when managing new episodes of low back pain, reports the Archives of Internal Medicine. (The analysis was conducted in Australia, but the guidelines assessed match those in the U.S.)
Researchers examined data on some 1700 visits to GPs for new low back pain from 2005 to 2008, after national guidelines for treating musculoskeletal pain were released. Among the findings:
Although guidelines recommend acetaminophen as a first-line analgesic, it was prescribed for only 18% of patients. NSAIDs and opioids were prescribed for 37% and 20%, respectively.
- One fourth of patients were referred for imaging, despite guidelines advising against routine referral.
- Only one fifth of patients received advice and education as recommended.
These findings were similar to those from the period before guideline publication.
The authors conclude: “The results indicate that in most cases, usual care is not evidence-based care and so is not likely to provide the best outcomes.”
