Chiropractic

WFC – Chiropractic releases news on Low back pain warns about ineffective treatments

Friday March 23, 2018

For immediate release.
Contact for more information: Dr Richard Brown, WFC Secretary-General
Email: rbrown@wfc.org

WFC Calls For Focus On Conservative Spine Care As New Study Reveals Millions of People Harmed By Wrong Treatments For Low Back Pain.
World Federation of Chiropractic President, Dr Espen Johannessen has called for greater utilization of chiropractic following the publication of a damning new study on low back pain treatments.

Millions of people across the world are getting the wrong care for low back pain, with many treatments causing harm and even early death, a global review published has confirmed.

The review was conducted by over 30 leading experts in countries across the world, including two chiropractors: WFC Research Council member Professor Jan Hartvigsen and Dr Alice Kongsted. The study, published in The Lancet today, highlights that many health systems are wasting valuable healthcare resources by continuing to fund tests and treatments known to be ineffective and even harmful.

The series of three papers on low back pain notes that standardized approaches to managing low back pain are commonly misconceived and outdated, and best practice is frequently ignored.

Worse still, the series adds, the interests of companies and healthcare professionals, who stand to gain financially from promoting unproven medicines or unnecessary scans and surgery, are often given priority over those of patients.

Speaking today, Dr Johannessen, emphasized that non-drug, non-surgical approaches must be the standard of care in the management of low back pain.

“This international study is a wake-up call for all health professionals, including chiropractors, caring for back pain sufferers,” he said. “It is not simply about avoiding the use of drugs and surgery, although we can see from this report that they are often not the best approach for most people. It is also about ensuring that patients are not exposed to unnecessary tests and that chiropractors and others take note of evidence-based guidelines.”

“This is a huge opportunity for chiropractic to be part of the solution for low back pain. As highly trained conservative spine care experts, chiropractors are trained to deliver many of the best practices recommended for low back pain. Manual therapy, including spinal manipulation, therapeutic advice, exercise prescription and rehabilitation techniques are all within the scope of practice of a chiropractor. Furthermore, chiropractors’ utilization of the biopsychosocial model also takes into account patients’ attitudes and beliefs about their low back pain and can help outcomes by providing valuable education, advice and reassurance.”

Professor Rachelle Buchbinder, leading world expert and chair of The Lancet working group on low back pain said “The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work. Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.”

“In many countries, for example, opioids that have limited positive effect but carry substantial risk of addiction, overdose and even death are routinely prescribed for low back pain.  In the USA, some 60% of people presenting for low back pain in emergency departments are prescribed opioids.  As a result, people are dying unnecessarily every day from overdoses.”

“Our review calls for this colossal waste of precious lives and resources to be stopped.  As lower-income countries respond to this rapidly rising cause of disability, it is also critical that they avoid the waste and harm that these misguided practices entail.”

What is going wrong – the facts:

  • Low back pain is the number one cause of disability worldwide; more than lung, bowel and breast cancer combined (while, however, major progress is being made in tackling cancer, the proportion of global disability due to low back pain has more than doubled in the last 25 years and is just getting worse)
  • At any one time, around 540 million people, mostly of working age, are experiencing low back pain
  • Misconceptions about best practice among healthcare professionals, funders and even patients themselves result in many people getting the wrong care:
    • There is no evidence that routine back imaging improves outcomes, but patients referred for imaging are significantly more likely to receive unnecessary care and surgery
    • US$12.8 billion was spent on spinal fusion surgery in the USA in 2011, despite it having significant failure rates and there being little evidence to support its use for most back conditions
  • Unenlightened compensation and workplace policies are driving unnecessary sickness absence and high social costs:
    • Sustainable return to work rates of people with chronic low back pain vary widely between countries, ranging in one study from 22% in Germany to 62% in the Netherlands
    • Rates of benefit claims related to back conditions are 60 times higher in the USA than in Japan
  • Low back pain is contributing to poverty and inequality:
    • A study of farmers in rural Nigeria found that, in one year, over half had been forced to reduce their workload due to low back pain
    • In Australia, the median wealth of people aged 65 who retire early because of low back pain is just over AU$5,000, compared to more than AU$330,000 for those who remain in the workforce
What needs to be done

The Lancet study made the following recommendations:

  • Healthcare funders should stop paying for ineffective and harmful tests and treatments, and commission research on those that are unproven
  • New tests and treatments should not be marketed before they have been adequately tested for safety, efficacy and cost-effectiveness
  • Standardized approaches to managing low back pain should be redesigned and payment systems changed to ensure delivery of the right care to patients
  • Health and social servi
  • ces should work with employers to provide support and incentives to stimulate early return to work, and to define work conditions adapted to employee capacity
  • Inaccurate beliefs about low back pain should be challenged, and patients taught to self-manage low back pain whenever possible
  • The World Health Organization should promote urgent action to improve the effectiveness of prevention and treatment for low back pain in low- and middle-income countries, including the adoption of alternate healthcare and financial models
  • Research and funding bodies should invest in research to address gaps in the understanding of low back pain, and to determine how best to put existing knowledge and evidence to use.
Dr Johannessen concluded:  “For some, adapting to recommendations contained in this study will be challenging. Like all health professionals, chiropractors must engage in critical evaluation of what works best, and be prepared to change in line with what evidence is telling us. Safety, effectiveness and cost-effectiveness are all critical considerations as we provide chiropractic care to create healthier societies and many of the findings reflect what chiropractors have been advocating for many years.

“This series of papers truly demonstrate that as collaborative partners, chiropractors are well-equipped to make a significant contribution in the management of low back pain.”

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