Sad But True: Family doctors still ignore guidelines for low back pain

Medical care for low back pain has a split personality: the experts “get it” and their opinions are widely published and accessible, but general practitioners either haven’t read the guidelines or ignore them. A new study in the Archives of Internal Medicine shows that family doctors aren’t caring for low back pain the way that their own expert colleagues recommend.

The paper presents strong evidence that general practitioners are simply not using best practice guidelines for the care of low back pain, even many years after they have been widely publicized in the medical literature. Williams et al looked at more than 3500 new cases of low back pain, comparing the advice patients got to the advice they should have gotten:

…the usual care provided by GPs for LBP does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients. This situation has not improved over time.

In particular, GPs:

• failed to reassure patients
• prescribed unnecessary, expensive and emotionally intimidating medical testing to look for largely non-existent and/or irrelevant “structural” problems
• failed to prescribe simple pain killers which could reduce symptoms and anxiety with virtually no risk
• failed to recommend massage therapy, even though it has always been an intriguing option, and is now also an substantively evidence-based treatment option (as established by a good quality scientific review in 2008)

(The Williams paper doesn’t discuss that last one — indeed, the survey predates the evidence — but it’s a pet peeve of mine that strongly fits in with the pattern of failing to give good advice.)

In a weird way, this website depends on front-line health care professionals failing to give good care. The whole point of SaveYourself.ca is to provide better information — the kind of information that you should get but often don’t get from most health care professionals. So it’s strangely reassuring to me when doctors and scientists publish detailed criticism of their own practices, confirming that there really are common problems with low back pain care, and that there really is a need for better information.

So this new paper strongly validates my position that patients are routinely getting poor quality information about low back pain — and could really use a readable and current guide to low back pain management. And, interestingly, so can the doctors. I know I have have many GP customers already, but I’d like to see more of them buy and read my ebook — they could clearly use it, and would probably find it much more enjoyable to read than a scientific journal.