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GPs urged to tailor back pain treatment to long-term risk of disability

GPs should tailor treatment for back pain according to an assessment of the patient's risk of long-term disabling back pain, say researchers.

Researchers from Keele University have found initially assessing people presenting with back pain symptoms as having low, medium or high risk of long-term and disabling problems helped target more appropriate treatment.

The preliminary findings of the study were first reported by Pulse in May this year, and researchers say that the approach ‘substantially' reduces the time GPs spend dealing with the problem and healthcare costs.

The report – published online by the Lancet today - authors argued that current care, such as advice, painkillers or referral to a physiotherapist, was based on ‘intuition' which was ‘inefficient and inconsistent'.

In the study, 283 patients were treated normally and 568 were assessed as having low, medium or high risk of long-term and disabling back pain.

Low-risk patients were given advice by a physiotherapist. Medium-risk patients received intensive physiotherapy. High-risk patients had physiotherapy and help to overcome psychological barriers to recovery, which can occur in chronic conditions.

After 12 months, the targeted groups showed significantly more improvement compared with the traditional treatment group. The study said the benefit was achieved at lower cost - saving more than £30 per patient on average.

Writing in the Lancet, researchers said the findings would have ‘important implications' for the treatment of back pain.

Lead researcher Professor Elaine Hay, director of the Research Institute for Primary Care and Health Sciences at Keele University, said: ‘The problem for GPs and other health professionals is spotting who, amongst the patients they see with back pain, is likely to get better with simple advice and reassurance, and who might benefit from further treatment from a physiotherapist.'

She said 50 centres in the UK had already adopted the new approach: ‘The data shows that it is having a substantial beneficial impact where it is being implemented.'

 Dr Louise Warburton, GP in Telford and GPwSI in Rheumatology and Musculoskeletal Medicine, said: ‘I know that if GPs were able to stratify patients at initial diagnosis and spot those with yellow flags, which are markers of chronicity, then the patients could be treated more aggressively and in a different way. They will not respond to physical therapies alone.'

‘I would be very keen for this approach to be rolled out across General Practice and I'm sure it would have enormous impact on quality of life and reducing absence from work.'

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