Unnecessary surgery for back pain in many countries

Millions of people all over the world receive the wrong treatment for low back pain, according to a newly published international study. This global study, published in The Lancet, concludes that many treatments harm more than they heal, and are unnecessarily expensive for the medical care system.

Physical Therapy is an effective treatment for Low Back PainPhysical Therapy is an effective treatment for Low Back Pain Photo credit: Emma Busk WinquistAround 30 leading experts in spinal research from several countries have participated in the study. The articles focus attention onto the way in which medical care systems in many countries use valuable resources to finance investigations and treatments that have been shown scientifically to be ineffective and, in some cases, harmful.

"Most people who suffer from back pain can be completely restored with the aid of training and various strategies to manage the pain. However, these patients are often instead given much more aggressive treatment that in some cases risks prolonging the condition," says Birgitta Öberg, professor of physiotherapy at Linköping University and one of the authors of the article series.

Back problems are now the most common cause of disability function and sick leave in the world, more than, for example, several common forms of cancer taken together. The number of people with a disability caused by back problems has more than doubled during the past 25 years, and continues to increase.

Many patients and those who treat them have an exaggerated belief in radiology-based diagnosis and surgery as the only treatment for back problems. There is, however, no scientific evidence that routine radiological assessment improves patient results, while the authors claim that it does lead to an increased risk of unnecessary treatment. Birgitta Öberg, professor in physioterapyBirgitta Öberg, professor in physioterapy. Photo credit: Emma Busk Winquist

"Surgery should be offered only to a small and carefully selected group of patients where the assessment has shown more serious symptoms. In Sweden, approximately 10% of patients who present with back problems undergo surgery. For most of them, it is important that the effects of physiotherapy are thoroughly investigated before deciding to proceed to more extensive treatment of, for example, spinal disc herniation, spinal stenosis and other long-term conditions. The medical care system must dare to resist a patient who wishes to undergo radiology and surgical treatment, since we know that the prognosis is usually good, and that different forms of training are in many cases the most effective treatment," says Birgitta Öberg.

The average total cost to society for an episode of back problems is SEK 65,000 in Sweden, 75% of which is the cost of sick leave and early retirement. There are huge differences between patients in the total cost to society, from SEK 10,000 to SEK 400,000, where the higher cost is incurred by those who undergo surgical treatment.

"It's been shown that it is beneficial to remain active when back problems arise, and a close collaboration between employer and caregiver is needed in order to make it possible for the patient to return to work as soon as possible. It is also important that new methods of assessment and treatment are not introduced before they have been thoroughly evaluated," says Birgitta Öberg.

The article series: The Lancet Low Back Pain Series”, The Lancet Low Back Pain Series Working Group, The Lancet, publicerad online 21 mars 2018, includes:

Article 1: What low back pain is and why we need to pay attention, Jan Hartvigsen, Mark J Hancock, Alice Kongsted, Quinette Louw, Manuela L Ferreira, Stéphane Genevay, Damian Hoy, Jaro Karppinen, Glenn Pransky, Joachim Sieper, Rob J Smeets, Martin Underwood on behalf of the Lancet Low Back Pain Series Working Group, https://doi.org/10.1016/S0140-6736(18)30489-6

Article 2: Prevention and treatment of low back pain: evidence, challenges, and promising directions”, Nadine E Foster, Johannes R Anema, Dan Cherkin, Roger Chou, Steven P Cohen, Douglas P Gross, Paulo H Ferreira, Julie M Fritz, Bart W Koes, Wilco Peul, Judith A Turner, Chris G Maher on behalf of the Lancet Low Back Pain Series Working Group, http://dx.doi.org/10.1016/S0140-6736(18)30489-6

Article 3: Low back pain: a call for action”, Rachelle Buchbinder, Maurits van Tulder, Birgitta Öberg, Lucíola Menezes Costa, Anthony Woolf, Mark Schoene, Peter Croft on behalf of the Lancet Low Back Pain Series Working Group, http://dx.doi.org/10.1016/S0140-6736(18)30488-4

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