Low back pain is simultaneously one of the most common and vexing pain conditions physicians treat. According to the International Association for the Study of Pain (IASP), low back pain (LBP) is the leading cause of years lived with disability and is a major public health concern worldwide. Physicians who change how they frame the condition, specifically, not as an injury, may reduce healthcare expenditures as well as improve patient outcomes, based on a recent study.
Clinical practice guidelines for treating LBP typically recommend multimodal treatment strategies that include biopsychosocial approaches, beginning with self-management; exercise and physical activity; massage and spinal manipulation; and psychological therapies before moving on to pharmacological treatment or more invasive strategies, such as nerve blocks and surgery. Imaging is generally not recommended unless there are specific indicators that a serious condition may be causing the pain.
AVOID EARLY INTERVENTION
Intervention for Low Back Pain is Often Too Early
However, these guidelines are not as widely followed as might be ideal. “Despite these recommendations, a current practice commonly involves an overuse of opioid medications for pain relief, inappropriate spinal imaging, and potentially harmful interventional procedures, including surgery,” wrote Wilson et al in their Applied Health Economics and Health Policy paper.
Among common barriers to the implementation of recommended practices, Wilson et al found inadequate knowledge of or confidence in best practices on the part of clinicians, patient requests for more interventional treatments, and inadequate time for more personalized care.
FREE APPROACH
FREE Approach Calms Fear, Promotes Self-Care
In their study, the team, based in the UK and New Zealand, assessed the effectiveness of an LBP intervention known as the Fear Reduction Exercised Early (FREE). This approach includes five hours of education and training for primary care physicians; resources for patient support, such as education, advice, and reassurance; and support for electronic consultation to help ensure adherence to guidelines.
“Guideline recommendations and the FREE approach aim to help clinicians and patients to reduce the perceived need for medical intervention to manage LBP,” thus reducing the need for future care, they wrote. This is accomplished by helping patients develop both the skills and confidence to self-manage their pain. “The FREE approach,” they added, “emphasizes that LBP can occur without injury and that framing it as an injury risk unnecessarily medicalizing LBP and may have negative consequences on the patient’s perception of fragility and willingness to return to physical activity.”
FREE Approach Reduces Injury Insurance Claims, Healthcare Costs
The researchers analyzed data drawn from nationwide injury insurance claims records in New Zealand over a 33-month period. They analyzed the association of FREE training with injury insurance claims, healthcare utilization, and costs by comparing LBP claims and associated activity with non-musculoskeletal injury claims for the same periods, before and after the physicians underwent FREE training. They then compared that data with the same data for physicians who were not trained in the FREE method.
The data showed an estimated 19% reduction in injury claims over a 33-month period, a result consistent with previous results from an RCT that had looked at the method’s effectiveness over a 6-month period. The results of the new study, the researchers argued, suggest that FREE-trained physicians are less likely to ascribe LBP to an injury, and as a result, patients are more confident of their ability to recover without additional treatment.
By referring patients less often to other medically unnecessary and potentially harmful health services, Wilson et al stated in their paper, FREE-trained doctors can have a positive impact on the cost and effectiveness of patient care.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888, or (516) 419-4480 for the Long Island office, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
