“Across the globe (there is) inappropriately high use of imaging, rest, opioids, spinal injections and surgery. Doing more of the same will not reduce low back pain disability nor its long term consequences.” – Professor Rachelle Buchbinder
Today, Federal Minister for Health Greg Hunt MP officially opened the NHMRC Centre for Research Excellence for the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network, to be run by Monash University, at the Cabrini Institute.
The opening coincided with a series of groundbreaking papers from Australian and international researchers in The Lancet published today (22 March 2018) warning that low back pain is a major health burden globally and that the current use of x-rays and scans, opioids, injections and surgery to investigate and treat the condition is useless, unnecessary and harmful.
Low back pain is the leading cause of disability globally – with more than 540 million people affected by activity-limiting low back pain at any one time. The burden from low back pain has doubled in the last 25 years, and the prevalence of the condition is expected to continue to increase with an aging and increasingly obese population.
According to the lead researcher of one of the three Lancet papers Professor Rachelle Buchbinder, Director of the Monash University Department of Clinical Epidemiology at the Cabrini Institute, “the burden from low back pain has reached a tipping point where the condition is growing rapidly, is poorly understood and is being mismanaged medically – at cost both to the patient and to the healthcare system. Low- and middle-income countries are already emulating the low-value care that is endemic in high-income countries”.
The other Australian lead authors are Professor Chris Maher, Associate Professor Manuela Ferreira and Professor Paulo Ferreira from the University of Sydney and Associate Professor Mark Hancock from Macquarie University. The international team behind the series comes from Brazil, Canada, Denmark, Finland, Germany, South Africa, Sweden, Switzerland, The Netherlands, UK and USA.
The final paper in the series by Professor Buchbinder is a worldwide urgent global call to action that seeks:a
The NHMRC Centre of Research Excellence for the ANZMUSC Clinical Trial Network, with hubs in both Sydney and Melbourne, is a collaboration of more than 200 clinician-researchers from 21 universities, 21 hospitals and ten research institutes. Led by Professor Rachelle Buchbinder, the aim of ANZMUSC is to optimise musculoskeletal health by addressing the “paucity of high quality research that has been focused on arthritis and musculoskeletal conditions, despite these conditions affecting 28% of Australians,” she said.
Two of the three papers outline the breadth and impact of low back pain globally, how medical care is making the problem worse in both developed and developing countries, and promising solutions that need testing. According to Professor Maher, there is room for hope. “There are safe effective treatments for low back pain; the challenge is ensuring patients get the right care at the right time,” he said. “A better understanding of low back pain, and changes to the way care for low back pain is delivered and reimbursed, are key to reversing the problems we see now.”
Robert Joseph (60) of Malvern East was a young man when he injured his back working with the airline TAA in the late 1970s. He lifted a heavy battery out of a plane triggering decades of chronic low level back pain, which occasionally spasmed (usually due to a poor lifting practice). Since then, he has self-managed the pain, particularly over the last decade by doing flexibility exercises every morning and bike riding four times a week. His most recent flare-up was 12 months ago when he asked Professor Rachelle Buchbinder what he could do, expecting a prescription for pain relief. “Instead she told me I had to get out of bed and have at least walked around the block by the end of that day. I could barely move, so I thought even getting out of bed was ambitious,” he recalls. “But I did try walking around and then thought – OK I’ll try doing the walk around the block, the first part of which I walked like an old man, completely doubled over. But then the back started to loosen up and the next day I went to work.” He now knows that the best treatment for back pain is movement.