In 1949, António Egas Moniz shared the Nobel Prize for physiology and medicine for using the prefrontal lobotomy as a treatment for people with mental illnesses. In hindsight, this is viewed as an embarrassing reflection of the era’s treatment of people considered mentally ill, but it also reminds us how – intentionally or unintentionally – negligent and harmful treatments and practices in medicine can be. Lower back pain is the latest example of this. Many of the 540 million people afflicted with this are not only receiving treatment that isn’t healing their injury but exasperating it.
The Global Burden of Disease Study (GBD) from last year concluded that lower back pain is the largest cause of disability in most high-income countries, and many middle/lower-income countries in areas as diverse as North Africa, Latin America, and Eastern Europe. Additionally, the GBD analysed the economic impact and concluded that 1 million years of productive life is lost in the UK, and 3 million years in the USA per year. Three papers recently published in The Lancet have included contributions from the Warwick Medical School which has investigated the extent of such mistreatment. This treatment often goes against guidelines that recommend exercise, swiftly returning to work, and educating patients on lifestyle changes that prevent lower back pain.
The GBD analysed the economic impact and concluded that 1 million years of productive life is lost in the UK, and 3 million years in the USA per year
Around one-third of people who have lower back pain will have recurrent lower back pain less than a year after recovering from it; the disorder is considered a long-lasting condition for such patients. However, identifying a cause is incredibly hard with only 1% of cases being linked to a serious disease like cancer or an infectious disease. Professor Martin Underwood of the Warwick Medical School says that “in the vast majority of cases we don’t know what the cause is”, and diagnosis is made harder by the fact that psychological and socioeconomic factors also contribute.
High-technology intervention is a major problem due to its leading practitioners to treat red herrings. MRI scans are favoured but can lead doctors to focus on non-relevant physical abnormalities, which then leads to unhelpful and expensive surgeries such as fusing discs or inserting artificial discs in the spine. Treatment with such operations is common practice in the US whose reputation as a global leader in medical research is influential in encouraging other countries to adopt such unhelpful practices.
Identifying a cause is incredibly hard with only 1% of cases being linked to a serious disease like cancer or an infectious disease
Whilst the NHS is less likely to offer surgeries, the papers highlight a worrying trend of prescribing injections or opioid painkillers which occurs in the USA and NHS. Around 60% of the 2.6 million lower back pain patients who visited the emergency room in the USA were given opioids for treatment and such prescriptions are on the rise within the NHS, despite recently conducted trials showing safer drugs to be equally effective. This is particularly concerning, not only for the cost of such drugs but the links towards the US’ opioid epidemic.
Furthermore, the most effective solutions aren’t always recommended. As mentioned, exercise is pivotal to treating lower back pain, but roughly 50% of people with lower back pain aren’t prescribed exercises. Not only has this had consequences for Americans, but to other countries which have adopted such practices which are becoming entrenched in some middle/lower income countries. Studies suggest India often recommends bed rest, and South African healthcare typically only offers painkillers.
Exercise is pivotal to treating lower back pain, but roughly 50% of people with lower back pain aren’t prescribed exercises
Some countries have begun addressing the proliferation of harmful treatment, including the Netherlands and Australia attempting to not pay for certain invasive treatments. However, the epidemic requires tackling systemic failures, with the series author Professor Jan Hartvigsen writing: “low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo.” With lower back pain increasing by 12% from 1990 and 2010 and estimating to cost the already strained NHS £2.1 billion in 2008, action is urgently needed to end the worldwide overuse of misdiagnosis and mistreatment.