Testing Tried-and-True Treatments for Low Back PainThere is a new direction for medical treatment these days. It's called "evidence-based treatment." Insurance companies, health care groups, and government agencies are demanding proof that medical treatments actually work.
This new move is taking hold in the United States and many other countries. In Australia, the first study of evidence-based treatment of low back pain has been reported. Two groups of people with back pain were studied. The first group received care from a medical specialist with advanced training in muscle or bone injuries. The second group was seen by their regular doctor, usually a general practitioner.
The medical specialists used a specific treatment program. The treatment guidelines were decided by reviewing all the reports and articles available on the treatment of low back pain. Evidence-based practice included use of a formal home program, manual therapy by the doctor, and injections into painful muscles. The general practitioners provided their usual care of X-rays, anti-inflammatory drugs, heat, and rest.
Nurses interviewed everyone in both groups during and after treatment at three, six, and 12 months. The nurses talked with patients in the clinic and later at home visits. At three months, there wasn't much difference between the two groups. By six and 12 months, the evidence-based treatment group showed a faster, fuller recovery with less pain and return of symptoms.
There were cost differences, too. General practitioners spent more money ordering X-rays and imaging studies. The medical specialist group had fewer patients returning with back pain, so there was less cost in the long run. The average cost per patient in the general care group was $472 (Australian) compared to $276 in the specialist group.
It's still not clear whether the evidence-based guidelines made the difference. Is the actual treatment more effective? Or do patients have greater confidence in specialists? The majority of patients in the evidence-based clinics gave their care excellent ratings. Less than half of the patients in general care gave their treatment such high ratings.
Most interesting of all were the comments of patients in the evidence-based group. They said that pain and symptom relief weren't nearly as important as the reassurance and sense of power they'd received. Some of these people were completely satisfied with their care even though they still had pain. Tried-and-true treatments clearly have a greater impact on back pain and patients with back pain.
Brian McGuirk, FAFOM, et al. Safety, Efficacy, and Cost Effectiveness of Evidence-Based Guidelines for the Management of Acute Low Back Pain in Primary Care. In Spine. December 1, 2001. Vol. 26. No. 23. Pp. 2615-2622.
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