MELBOURNE, Australia—Primary care doctors who report a special interest in back pain may be giving their patients outdated advice such as encouraging bed rest, finds a new study of Australian general practitioners in the May 15 issue of Spine.¹

“These findings raise serious concerns about how back pain is currently being managed among general practitioners with a special interest in low back pain,” conclude the researchers, who were led by Rachelle Buchbinder, PhD, of Monash University in Melbourne, Australia.

In the new study of 4,000 doctors who answered a standard questionnaire regarding their knowledge and beliefs about how to treat low back pain, 16% reported a special interest in back pain. The physicians who said they were interested in back pain tended to know less about the most recent evidence-based findings on how to treat low back pain than their counterparts who did not report having a special interest in treating back pain. Specifically, 18% of the general practitioners with an interest in back pain said that they thought patients should be placed on complete bed rest until the pain subsides. Bed rest is no longer recommended. Instead, early ambulation and quicker return to normal activities are encouraged for back pain patients.

Changes in back pain CME needed

Physicians with a special interest in back pain were also more likely to believe that low back pain patients should avoid work until the pain is gone. The most recent evidence suggests otherwise. In fact, such extended leaves may even increase the risk of the back pain becoming a chronic problem.

The primary care physicians who were interested in treating back pain also thought that lumbar spine radiographs were helpful in diagnosing back pain, but this is not true.

Overall, this disparity in knowledge about how to treat low back pain held even after adjusting for continuing medical education (CME).

In general, doctors who had recently taken a CME course were more well-versed on the latest research, but doctors with a special interest in back pain were less well-informed than other physicians even if they had recently taken such a course.

“Scrutiny of postgraduate education courses about back pain may also be needed to ensure that the content is in line with the best available evidence,” the researchers write. "The seeming inability to influence the interests of physicians with special interests in back pain raises the possibility that these beliefs may be recalcitrant to change.”

Doctors who had a special interest in occupational medicine were more knowledgeable about back pain, but those with a special interest in musculoskeletal medicine were not, the study found.

The study does have some limitations. The new study examined the beliefs of the doctors, not their behaviors, and physicians’ beliefs are not always in accordance with their treatment decisions, the researchers point out.

Back pain: when in doubt, refer them out

New York City-based sports medicine physician Lewis Maharam, MD, medical director of the ING New York City marathon and author of several books including A Healthy Back: A Sports Medicine Doctor's Back-Care Program for Everybody, discussed the study with MSKreport.com.

“Physicians who treat back pain should position themselves as such, but if they are not interested in spending the time with the patient and coming up with an exact treatment plan then they should not bother treating low back pain patients and refer them out,” Dr. Maharam said.
 
References

1. Buchbinder R, Staples M, Jolley D. Doctors with a special interest in back pain have poorer knowledge about how to treat back pain. Spine. 2009;34:1218-1226.