Low Back Pain? What does the science say?
Low Back Pain is frustrating and unfortunately very common; it is currently hailed as the leading cause of disability worldwide. While treatments abound, there is no gold standard treatment for low back pain that universally works for everyone. And the condition can be frightening...with many people going to the emergency room for treatment due to the pain. But does this always lead to best care? Well, we know it doesn't lead to the best care. And, often, the side effects from the treatments sometimes make the patient worse.
The state of the evidence was summarised in 2018 in the Lancet Low Back Pain series. The guidelines have remained stable, more or less, for several years. However, implementation of the guidelines remains an ongoing challenge. Clinicians, patients and public at odds with the best scientific advice. Unfortunately, this leads to low value care, or care which does not help the patient in the long term, or, may worsen their outcomes. An example of a worsening outcome is early referral for surgery, or prescription of opioid analgesics potentially leading to dependency. Yet another study found difficulties with implementing best practice guidelines. This was published in BMJ Quality and Safety, and found that despite extra training, the education of professional failed to reduce the use of imaging for Low Back Pain. It did, however, reduce opioid prescriptions on average 12%, but at one hospital up to 24%.
Some simple, guideline-recommended suggestions for low back pain are to continue to remain active, avoid prolonged bed rest and use heat packs or heat wraps to sooth your pain. The BMJ study from above found that simple heat wraps were effective, and patient's pain was no worse in their trial.
Perhaps trying a heat wrap or hot water bottle is a worthwhile treatment for your next episode of back pain?