Guidelines for Low Back Pain: A Nice Suggestion?Almost half of all workers' compensation claims are for back injuries. For this reason the Worker's Compensation Board (WCB) in Canada sent out guidelines for family doctors to use. The guidelines are called Clinical Practice Guidelines (CPGs). They are based on the best and most recent scientific studies. Expert panels in other countries have come up with similar ideas for managing patients with back pain.
CPGs tell the doctor what questions to ask, how to examine the patient, what to watch for, and what treatment to suggest. Family doctors were given the CPGs because they are who patients most often turn to for this problem. This study looked at how well family doctors in Canada are following the WCB guidelines. There is a hope that if every health provider followed the guidelines, then patients would be examined and treated the same way. Results could be measured, and the best methods for taking care of acute low back pain would emerge.
The authors report that family doctors were doing a good job reviewing the patient's history. They usually asked about prior episodes of similar symptoms. Two-thirds of the doctors carried out the kind of examination recommended in the guidelines. However, only five percent of the doctors looked for "red flags" that come with more serious conditions.
Treatment is the area where many doctors didn't follow the guidelines. For example, 40 percent of the doctors prescribed the use of narcotic drugs more than four weeks after the injury. Half the doctors sent their patients for passive therapies after that point, which the CPGs say is too late. Only a few doctors offered their patients education or reassurance.
Setting up CPGs is the first step in finding the most effective treatments for a problem. Finding ways to get everyone to use the CPGs is the second step. Then studies must be done to show what happens when patients receive treatment based on the guidelines. Short-term and long-term results must be studied. The goal is to reduce the number of patients who have chronic pain.
These Canadian doctors say the final step is to refine the guidelines. All of this research will result in the next generation of CPGs. The process will repeat itself many times until there are guidelines and successful treatments for all kinds of back pain.
Paul B. Bishop, DC, MD, PhD, et al. Compliance with Clinical Practice Guidelines in Family Physicians Managing Worker's Compensation Board Patients with Acute Lower Back Pain. In The Spine Journal. November/December 2003. Vol. 3. No. 6. Pp. 442-450.
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