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Low back pain the top cause of disability, gets wrong treatments

Poor treatment is fueling the opioid epidemic
by Maggie Fox /
Image: Lower-back pain
Despite guidelines from top medical groups, studies and recommendations, doctors still tend to prescribe pain pills to people with back pain instead of physical therapy and exercise, which work better, according to the reports in the Lancet medical journal.Hin255 / Getty Images/iStockphoto

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Low back pain is the top cause of disability globally, yet most people are getting the wrong treatments for it, a new survey shows.

And nowhere do more people get the wrong therapy — opioids — than in the United States, the international study found.

Despite guidelines from top medical groups, studies and recommendations, doctors still tend to prescribe pain pills to people with back pain instead of physical therapy and exercise, which work better, according to the reports in the Lancet medical journal.

"In many countries, painkillers that have limited positive effect are routinely prescribed for low back pain, with very little emphasis on interventions that are evidence based such as exercises,” said Nadine Foster of Britain’s Keele University, who helped lead the study team.

In the U.S., for instance, more than 60 percent of people with low back pain get opioids. Incorrectly use of opioids is helping to drive the ever-worsening opioid overdose epidemic in the U.S.

“More than half the total number of people taking opioids long-term have low back pain,” the report notes.

The Centers for Disease Control and Prevention says opioid overdoses went up 30 percent between 2016 and 2017. Opioid overdoses kill around 35,000 people a year, the CDC says.

Lower back pain costs 3 million years of productive life every year in the U.S. — a calculation that takes into account both people affected and how long their pain keeps them out of work.

The causes are not obvious.

“Rarely can a specific cause of low back pain be identified,” the researchers wrote.

“People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain.”

The problem’s likely to get worse as people live to older ages, the researchers predicted.

Studies show what works best to treat lower back pain: physical therapy, psychological counseling, stretching, massage and other non-invasive treatments. Rest rarely helps: all patients should be urged to stay active.

The American College of Physicians says in its guidance that patients with lower back pain should try heat wraps and exercise first, and prescription drugs should be used only as a last resort.

But that’s not what patients are getting.

“Only 12 percent of people with chronic low back pain with depression in the USA had seen a psychiatrist or psychologist in the previous year,” the researchers wrote. Only 8 percent got cognitive behavioral therapy, which has been shown to help, and fewer than half are ever prescribed exercise.

Instead, people get painkillers and surgery, the report found. Surgery only works in rare and particular cases, the team noted. It is expensive and can lead to complications, yet it’s a popular choice.

“In the USA, in 2011, spinal fusion was responsible for the highest aggregate hospital costs of any surgical procedure,” the team wrote — costs that totaled $12.8 billion.

Not only are people getting inappropriate drugs or surgery, but they are being treated in the wrong places and being diagnosed using expensive and in appropriate technology, the report found. Patients are showing up in emergency rooms instead of going to primary care doctors.

And more than half of patients in the U.S. get some kind of imaging for low back pain, according to data from health insurance companies.

“The use of increasingly sensitive imaging techniques, such as MRI, can reveal findings that might be incorrectly inferred to be the cause of a patient’s symptoms,” Rachel Buchbinder of Australia’s Monash University wrote in a commentary.

“Increased use of ineffective potentially unsafe treatments has wasted limited health-care resources and harmed patients.”

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