Low back pain recommended/actual care gap is hurting patients

Key aspects of the usual care that general practitioners provide for patients with low back pain (LBP) do not align with the care recommended in evidence-based guidelines. The likely result is less than optimal outcomes.

Williams and associates compared actual care of patients with LBP against international “best practice” guidelines. Care provided during 3533 patient visits in Australia was mapped to key recommendations in the published guidelines.

Discrepancies between recommended and actual LBP treatment were observed on several fronts. Contrary to recommendations against imaging, general practitioners sent about 25% of their patients for imaging studies. Where the guidelines call for education and advice as first-line intervention for LBP, only about 20% of patients reported receiving counseling. Although the guidelines call for treatment with simple analgesics-acetaminophen-to control pain, 37.4% of patients received NSAIDs; 19.6% received opioid analgesics; and only 17.7% received acetaminophen, mostly at a dosage other than the recommended 4 g/d.

The authors noted that given that usual care is the control treatment in many trials of new treatments for patients with LBP, these trials may provide overly optimistic estimates of the effects of the new therapy.