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Lower back pain is often overtreated

Physical therapy highly effective in remedying common condition


Lower back pain is very common. In fact, experts claim that almost everyone will experience lower back pain at some point in life. However, even though lower back pain is common, the approach to treat the common condition can vary and in some cases, some treatment options may not be necessary.

To improve the patient care, Novant Health formalized a standard approach to treating adults who suffer from acute, non-traumatic lower back pain.

Acute, non-traumatic lower back pain is defined as an aching, burning, stabbing, sharp or dull pain in the lower back that lasts four weeks or less in the absence of any direct injury or trauma. Non-traumatic causes usually involve a back strain or sprain as a result of twisting or lifting something improperly, lifting something too heavy or overstretching. A physical exam can usually identify any serious conditions that may be causing the pain and help determine appropriate treatment options.

“Under certain circumstances, X-rays may be ordered to rule out specific causes of lower back pain but in most cases they are not warranted,” said Dr. Eric Warren of Novant Health Waxhaw Family & Sports Medicine in Waxhaw, North Carolina. “Unfortunately, across the industry, X-rays for lower back pain are highly overused or ordered too early in the treatment process. This is a considerable problem as it drives up unnecessary health care costs, can expose the patient to radiation unnecessarily, and often isn’t in the best interest of the patient.”

According to a recent study published in JAMA Internal Medicine, “approximately 31 percent of lumbosacral magnetic resonance imaging (MRI) scans performed were deemed inappropriate in the Department of Veterans Affairs (VA) and similar rates of inappropriate MRI use have been seen outside of the VA.”

Reducing unnecessary imaging is one place that many health care systems find to be an area of opportunity as they look to reduce patients’ health care costs and improve quality of care.

Novant Health and other health systems are educating providers about appropriate use of imaging and the benefits of a good physical exam and physical therapy.

“Early intervention is important and can reduce a patient’s chance of developing chronic lower back pain,” Warren said, adding that he would not recommend bed rest for patients. “In fact, I recommend patients with lower back pain try to remain active but avoid lifting heavy objects.”

“Through our research, we have not seen significant scientific evidence that injection therapies or the use of lidocaine patches, anticonvulsants, antidepressants or steroids are beneficial for patients with acute lower back pain,” he said. “Physical therapy appears to be an early helpful treatment option and is often indicated within the first month of experiencing pain.”

Novant Health’s physical therapy team has developed specific protocols to treat patients with acute lower back pain. However, if pain persists after three treatment sessions, Warren recommends that patients undergo a follow-up medical examination.  At that time, an X-ray may be necessary to identify if any underlying medical conditions exist, such as infection, kidney stones or even cancer.





Published: 12/15/2016