Clinical guidelines for the treatment of lower back pain do exist. However, not all physicians follow them, and those that do aren’t always steered in the right direction. Clinical guidelines for back pain treatment, as reported in the October 2007 issue of Annals of Internal Medicine, may not offer enough attention to the patient as an individual and to psychological factors associated with chronic pain.
Current clinical guidelines emphasize the importance of a physical examination, an attempt to determine whether the cause is related to a musculoskeletal or neurological issue, the frugal use of imaging technology, the use of NSAIDs for pain relief and self-care education. If these efforts fail, then physical therapy, chiropractic care and other treatment options are recommended.
For many patients, these guidelines don’t amount to effective or efficient treatment. In the interest of improving back pain treatment, researchers developed a new diagnostic tool called STaRT Back. The tool is a survey of nine questions for back pain patients to answer. Answers allow physicians to categorize patients into low-, medium- and high-risk groups. The group patients fall into determines their course of treatment.
Five out of the nine questions on the survey assess psychological factors, the importance of which in chronic pain is becoming more and more evident in research each year.
Patients who fall into the low-risk group are given self-care advice. Those in the medium-risk group are referred to physical therapy. High-risk patients receive a referral to both a physical therapist and psychotherapeutic intervention, such as cognitive behavioral therapy.
The use of these more specific and well-rounded guidelines yielded positive results in a 2011 study that compared disability scores of patients using the STaRT Back tool with the scores of those pursuing a typical treatment course in the U.K. The study found those in the STaRT group to have significantly greater improvements in disability scores, as well as modest cost savings over the typical intervention group. See more on this study at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60937-9/abstract.
More recently, a study found patients who used the STarT Back tool to spend 50% less time off work and to take less medication. Researchers found that those who fell into the high-risk category saw the biggest reduction in disability scores. See more on this study at http://www.annfammed.org/content/12/2/102.full.
Given the non-stellar track record of usual care and diagnostic procedures for lower back pain and the promising results of research into the STarT Back survey and treatment guidelines, physicians have reason to seriously consider implementing the latter in their practice. If you are a back pain patient seeking efficient, targeted treatment, try to find a physician who knows about or is willing to learn about the STarT Back survey and treatment guidelines.
