Better outcomes for back pain treated under medical guidelines

A study by University of Utah Health and MDGuidelines researchers found that people with lower back pain injury miss 11 more days of work in a year when they only receive treatments for lower back pain that are not recommended by medical evidence-based guidelines compared with people treated according to guidelines.

The data for the study, released Thursday, came from California workers compensation claims between 2009 to 2018 for 60,000 workers who had uncomplicated, acute lower back pain or strain, which researchers pegged as the most prevalent injury in the workplace.

The researchers then tracked whether treatments prescribed in clinic visits within the first week after injury were categorized as recommended or non-recommended in the peer-reviewed American College of Occupational and Environmental Medicine guidelines, with the assumption that similar treatment patterns would continue in any subsequent clinic visits. The researchers then calculated the number of lost workdays within the first year after injury, according to a statement.

They found that 14% received non-recommended treatments only, 51% received a mix of non-recommended and recommended treatments, 14% received recommended treatments only, and 21% did not receive any medical intervention.

Of them, the workers who received recommended treatments combined with non-recommended treatments saw an intermediate benefit, missing a median of eight workdays within the year as compared with those who exclusively received recommended treatments.

The study found the most common non-recommended treatments were prescriptions for opioids, which are discouraged because they reinforce debility instead of exercise and can be addictive, and X-rays, which can lead to inaccurate diagnoses. The most common recommended treatments were nonsteroidal anti-inflammatory drugs and muscle relaxants.

The study also found that the treatment practice that changed most drastically was opioid prescriptions, which fell by 86% over nine years. Researchers said the large reductions in opioid prescriptions for lower back pain suggest that “added incentives, such as insurance refusing to pay for non-recommended treatments, increases adherence to guidelines.”