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Researchers challenge guidelines for treating acute low back pain

Photo: Researchers challenge guidelines for treating acute low back pain
Researchers are calling for a review of clinical guidelines for treating acute low back pain following a study published today in JAMA Neurology that shows early, specialised care, which is recommended in global guidelines, does nothing to help a patient’s recovery.

In the first randomized, placebo-controlled trial for testing the effectiveness of early, specialised patient education for acute low back pain co-author Associate Professor James McAuley from Neuroscience Research Australia (NeuRA) says recommendations to include intensive early management in treatment for acute low back pain may be premature.

“Most people recover from acute low back pain without medical intervention. In our study, we were interested in treating those who were at risk of not recovering.

“Globally, major clinical guidelines recommend that health practitioners provide patient education to manage acute low back pain. This is the treatment for back pain that is currently the most accepted and recommended.”
Lead author of the study Dr Adrian Traeger from the University of Sydney added:
“The guidelines have also recently started saying that rather than give minimal care such as advice and reassurance, health practitioners should refer for early specialised care over multiple sessions if they identify a patient as being at ‘high-risk’ of developing chronic pain."
“Our study is the first to actually test this approach against a placebo and our results suggest that the recommendations were premature.”

The study followed 202 participants in Sydney who had experienced low back pain for less than six weeks and showed a high risk of developing chronic low back pain. All participants also saw their regular health practitioner during this study.

Participants in the intervention group received early, specialised care involving patient education over two one-hour sessions. The education focused on pain and contributing factors, and self-management techniques. Participants in the control group received placebo patient education – active listening, but without information or advice.

The trial showed that adding two one-hour sessions of specialised patient education to usual care of patients did not reduce pain intensity or lead to a meaningful reduction in the development of disability.

“These results challenge a widespread belief that patient education is an effective strategy for treatment of acute low back pain,” says A/Prof McAuley. 

“Adding specialised, time-consuming treatment to primary-care is unnecessary for most patients with acute low back pain.

“This has the potential to fundamentally change the way acute low back pain is managed in primary care.”

Key outcomes of this research suggest a basic approach to acute low back pain treatment should include simple advice on how to: remain calm and be reassured that your pain will get better; keep active and remain at work; avoid strong medications and to avoid imaging tests.

Back pain is the leading cause of disability worldwide, and second only to the common cold as a reason for visiting a general practitioner.

Associate Professor McAuley who leads the Pain, Research, Education and Management Program at NeuRA is focused on testing new interventions to treat those who have moved from acute to chronic low back pain, to provide much needed relief and long-term solutions.



“Ideally we don’t want people to develop chronic pain. We want to have a strong and robust methodology for GPs to manage low back pain at the grass-root level,” said A/Prof McAuley.

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