MEDIA RELEASE
TUESDAY 9 FEBRUARY 2010
BACK CARE DOESN’T MEASURE UP
According to national guidelines, the best care for acute lower back pain is simple: stay active, avoid
bed rest and take regular simple analgesics such as paracetamol. However new research has found
that only 20% of patients receive this simple treatment approach. Instead many are referred for
unnecessary imaging and prescribed more complex medicines such as ibuprofen.
In Australia, acute low back pain is primarily managed by GPs, physiotherapists and chiropractors.
New research conducted by The George Institute has revealed that the care received by patients
does not align with best practice recommendations in international evidence-based guidelines.
Importantly, this care may not be providing the best outcomes for patients and is likely to be
contributing to the high cost of back pain in Australia.
“We found a great difference between usual care and what is recommended in guidelines for treating
acute lower back pain. For example, guidelines discourage the use of imaging, but more than one-
quarter of patients were referred to imaging. Most patients did not receive the recommended advice
even though this is inexpensive and universally recommended for all patients. The challenge is how
we change practice so that it aligns with the evidence”, said author Professor Chris Maher, Director of
musculoskeletal research at The George Institute.
“One issue is the internet; it contains an interesting mix of information and misinformation. As a result
treating back pain for clinicians is more difficult than ever because of common misconceptions
patients bring with them to the consultation. A potential step in rectifying the situation is addressing
these misconceptions with key public health messages.”
Low back pain is the most prevalent and costly musculoskeletal condition in Australia¹, estimated to
cost up to $1billion per annum with indirect costs exceeding $8billion². In the United States, the direct
cost of treatment is over $50billion. The issues between care and guidelines have also been found in
1
Australian Institute of Health and Welfare. Australia's health 2000: the seventh biennial health report of the
Australian Institute of Health and Welfare. 7th ed. Canberra: AIHW, 2000.
2
Walker B, Muller R, Grant W. Low back pain in Australian adults: the economic burden. Asia Pacific Journal of
Public Health 2003;15(2):79-87.
3. Schofield DJ, Shrestha RN, Passey ME, Earnest A, Fletcher SL. Chronic disease and labour force participation
among older Australians. MJA 2008; 189 (8): 447-450
the United States, and highlight concern over what strategies are necessary to educate GPs in
providing guideline-based care.
Researchers assessed the care of 3533 patients who visited their GP regarding a new case of low
back pain. Treatment was mapped against international evidence-based guidelines for the
management of lower back pain. The research also reviewed the impact of the introduction of
guidelines in 2004, which showed that the treatment trends have not improved over time.
Paracetamol is endorsed in guidelines because it is a safe and cost-effective treatment. However the
true efficacy of paracetamol for a new episode of low back pain is unclear, and authors note that
perhaps because of this uncertainty only 20% of patients with new low back pain are prescribed or
recommended paracetamol.
“We know that most people with back pain do not take paracetamol correctly in fact, less than 10% of
patients with a new episode of low back pain take paracetamol regularly up to the daily recommended
dose”, said Professor Maher.
Researchers are now investigating the effects of paracetamol among 1650 patients from GP
practices in the Sydney metropolitan area, and will follow patients’ recovery for three months. This
study will find out whether taking paracetamol regularly is more effective than taking paracetamol on
an as-required basis. The results of this new study will have immediate implications for clinical
management of low back pain.
“If the findings demonstrate that a regular course of paracetamol is effective in speeding recovery, the
cost-savings to individual patients and to our healthcare system will be very significant, especially for
the 4 million people with back pain in Australia”, added Professor Maher.
The new study is being conducted at The George Institute with colleagues at the University of Sydney
and University of New South Wales.
###ENDS###
For further information, please contact:
Emma Orpilla – Public Relations, The George Institute for International Health
Tel: +612 8238 2424/ Mobile: +61410 411 983
Fax: +612 9657 0301/ email: eorpilla@george.org.au
The George Institute is a world renowned health and medical research institute, focused on the
prevention and management of chronic disease and injury. The George conducts high-impact
research across a broad health landscape and is a respected voice among global policy makers. The
George has conducted major global applied research projects and innovative community-based
programs from bases in Australia, China and India. In 2009, the Institute celebrates a decade of
discovery, innovation and impact. www.thegeorgeinstitute.org
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