More Guidelines

Low back pain experts, American Family Physician, have published guidelines for non-specific low back pain, adding to the collection of "high-quality evidence" that purports to guide clinicians but ignores the heterogeneity of back pain.  Medscape had repackaged for your convenience:

There is no clear evidence supporting the use of acupuncture, epidural steroid injections, muscle relaxants, spinal manipulation, transcutaneous electrical nerve stimulation, trigger point injections, heat therapy, and therapeutic ultrasound.

"Exercise conducted under the supervision of a therapist three to five times per week is highly recommended as first-line therapy in the treatment of low back pain," the study authors conclude. "However, there is conflicting evidence as to which type of exercise therapy is most effective."

Not without any good points,

Because radiography and magnetic resonance imaging findings do not correlate with clinical symptoms of nonspecific low back pain or ability to work, these studies should be reserved for patients with radicular symptoms who do not respond to conservative care and for those with worsening neurologic findings, objective weakness, uncontrolled pain, or suspected cauda equina syndrome.

Am Fam Physician. 2007;76:1497-1502, 1504.

Comments

[Derek]

Those who read the MyPTSpace discussion know I've posted on this before.

The same issues with other studies come up here as well. Treatment-based classification was ignored.

I do believe, however, that these guidelines continue to move the management of low back pain our way. Like you mentioned, it points out the problems with overutilization of imaging and that exercise under the guidance of a therapist is a good idea. It time to focus our consumer education on the benefits of classification.

[Matt]

Personally, I think this article is going to be great for my referring (and not referring MD's). The take home message is send them to a PT, not to the local MRI facility first, which wastes $$ and takes three weeks. It is not the MD's job to worry about our classification systems, it is ours! Every time I try to preach EBP to MD's, 90% of the time there eyes glaze over. Just send me the patients, I will use EBP to get them better, and the MD is happy. The most important part is to get them in your door!