By Liam Mannix
21 March 2018
Hundreds of thousands of Australian back pain sufferers are being given harmful or useless treatments, leading researchers say, prompting them to make an extraordinary plea to protect the public.
Thirty-one of the world’s leading back pain researchers have published a call to action in medical journal The Lancet saying lower back pain is being mistreated on an enormous scale.
Doctors regularly prescribe addictive opioids and potentially harmful treatments including spinal fusion surgery, despite there being little evidence these treatments work, they say.
Meanwhile, cheap treatments that do work are rarely prescribed.
“The elephant in the room is vested interests – among industry but also clinicians,” says Professor Rachelle Buchbinder, lead author of the editorial and an academic at Monash University and the Cabrini Institute.
Lower back pain is the leading cause of disability worldwide. One in two Australians experienced it in the past month; globally more than half a billion people were affected last year.
Nearly all cases have no specific cause. “We still don’t know why there are so many sufferers,” Professor Buchbinder says.
Some risk factors are known: obesity, inactivity, a job involving heavy labour. The condition has a significant mental component; disliking your job and depression are other strong risk factors.
Medicos lobby patients for dozens of different and often conflicting treatments. “The poor patient doesn’t know who to believe,” says Professor Buchbinder.
Despite limited evidence of their efficacy, most back pain treatments are funded by Medicare, costing taxpayers about $4.8 billion a year. Treatments proven to work – like yoga – are not subsidised.
“We waste billions. People are being treated with too much of the wrong stuff and missing out on the right stuff,” says Professor Chris Maher, a world-leading back pain expert based at the University of Sydney who co-authored a study on treatment published alongside the editorial.
“We have an industry that’s essentially allowed to do as it pleases in terms of marketing unproved products. People can make billions of dollars marketing something that’s unproven.”
Royal Australasian College of Surgeons spokesman Dr John Quinn said it was “almost certain” the medical industry influenced surgical decisions.
“But we cannot control what individual surgeons do in any given situation. It’s up to them to diagnose and treat their patients as they see fit.”
The best treatments happen to be the cheapest: exercise therapy and psychology. Above all, simply staying active when your back hurts is the best medicine.
“Lower back pain is like the common cold – it should just be considered a part of everyday life,” says Professor Buchbinder. “Most people with back pain, it gets better very quickly whatever you do.”
Robert Joseph has lived with back pain all his adult life after an injury hauling batteries as a young engineer almost 40 years ago. A year ago, the 60-year-old had a serious flare-up. Struggling to walk, he went to Professor Buchbinder, seeking painkillers.
“She refused to prescribe them,” he says, laughing.
“’What you’ve got to do’, she said, ‘is get out of bed and start walking around the house’.
“I said ‘Not a chance in hell’. But she said ‘You can’t injure your back from just walking around’.
“So I started walking around, bent over like a 100-year-old man, and then slowly it just kind of came good.”