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Highest risk patients 'should be targeted for low back pain treatment'

By Lilian Anekwe

GPs should vary the treatment they offer for low back pain according to the patient's risk of developing chronic pain, a new study suggests.

UK research, presented at the European League against Rheumatism conference this week, could offer GPs a workaround to the controversial NICE guidance on low back pain, which recommends acupuncture and spinal manipulation.

A Pulse investigation last September found GPs were being prevented from putting the guidance into action because primary care organisations were refusing to fund the alternative treatments.

Researchers from the University of Keele and Cambridge invited 2,793 adult patients with low back pain to receive initial treatment at a back pain clinic.

After the clinic treatment, patients were randomised to either targeted or control treatments. In the targeted treatment group, patients at a low risk of developing chronic low back pain were given a minimal intervention delivered by GPs, while those at medium risk were referred to primary care physiotherapy and high risk patients were given combined physical and psychological treatments.

The patient's risk of chronic pain was defined by the STarT Back Tool , whose items include disability, bothersomeness, catastrophizing and anxiety.

In the control group, therapists made decisions regarding physiotherapy treatment using clinical judgement and were unaware of patients' risk subgroup.

There were significantly larger mean reductions in the Roland-Morris Disability Questionnaire score for patients with targeted treatments compared with those in the control group after four and 12 months of follow-up.

Patients given targeted therapy showed a reduction of 4.7 points after four months and 4.3 after twelve months, compared to 3.0 and 3.4 respectively in the control group. There were also significant reductions with targeted therapy for pain intensity, anxiety, depression and satisfaction.

Professor Elaine Hay, professor of community rheumatology at the University of Keele, concluded: 'Significant clinical and cost benefits were demonstrated using a subgroup and targeted low back pain treatment approach in primary care.'

'Future studies should identify ways to implement low back pain screening and targeting into mainstream clinical practice, whilst better sustaining substantial short-term effects among high risk patients using combined physical and psychological treatments.'

EULAR 2011

Francisca Ulloa, flickr Highest risk patients 'should be targeted for low back pain treatment'

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