Millions of patients with back pain are being given pointless drugs, surgery and injections, with a third being prescribed dangerous opioids, experts say. Doctors prefer to offer useless and often harmful treatments rather than tell patients there is nothing to be done except stay active, an international group of scientists has found. Exercise and psychological therapy are the only things that work for most cases of chronic back pain, but too many people wrongly believe the myth that rest is best for the condition, they add. Job satisfaction and a positive attitude are among the strongest indicators of whether the back pain will turn into serious disability but their report, published today, says doctors are reluctant to discuss social and psychological approaches, preferring needless scans.
Back pain is the world’s leading cause of disability, with up to nine million estimated to suffer from it in Britain and half a billion worldwide, but a series in The Lancet says that it is routinely badly treated. In Britain, one in seven GP appointments is for muscle and nerve problems, mostly back pain. NHS guidelines recommend mainly exercise and therapy but Martin Underwood of the University of Warwick, one of the series’ authors, says they are often ignored. “In this country, it affects a huge number of people,” he said. “It’s something that we’re not very well equipped to deal with. Patients understandably look for solutions and a cure, but the reality is we don’t have a cure. We don’t understand what causes the vast majority of the back pain.”
Steroid injections are increasing, as are scans that often lead to surgery, a fifth of which makes the problem worse, Professor Underwood said. “The evidence underpinning these invasive treatments is very weak indeed. And they have harmed.” He pointed to studies showing that a third of British patients with back pain are given opioids such as tramadol, codeine and morphine but said, “If anything the evidence is that [opioids] can end up making your pain worse.” About 24 million opioid prescriptions are written by GPs each year, double the figure a decade ago. Ministers have launched a review into concerns that patients are becoming hooked and suffering dangerous side-effects.
Past studies have found that pills like paracetamol and ibuprofen barely help with back pain. Psychological techniques to help cope with pain can stop it leading to permanent disability, however. “Your belief system and psychological state are important predictors of whether you’re going to end up disabled. It’s a difficult message to get across,” Professor Underwood said.
Credit: Chris Smyth for The Times, 21 March 2018.