Primary Care for Low Back Pain: We Don’t Know the Half of It
SOURCE: Pain. 2020 (Apr); 161 (4): 663–665
Peter Croft; Saurabb Sharma; Nadine E. Foster
Primary Care Centre Versus Arthritis,
School of Primary, Community and Social Care,
Keele University, Keele, United Kingdom.
Evidence-based medicine helps health care professionals and patients decide best care, drawing on research about effectiveness and safety of interventions. Systematic reviews summarise the evidence; guidelines report consensus between experts (including patients) on interpreting it for everyday practice. Although guideline recommendations are only one component of shared decisions that will vary patient-to-patient, the hoped-for outcome is health benefit for each individual. Guidelines also inform starker decisions by policymakers and health care leaders — for example, when to withdraw approval or funding for a poorly evidenced or harmful intervention. To assess whether all this research-driven activity is useful, 2 questions need answering: how well are guidelines followed in real-life practice and do patients benefit in the long-term?
In a new systematic review, Kamper et al.  tackle the first question in relation to first-contact care for patients with low back pain provided by family practice and emergency department physicians. (aka “usual medical care”) As the authors state, low back pain has major significance for the international pain community. It is the leading single cause of years lost to disability globally,  and there is good evidence for what constitutes best first-contact treatment.  The review selected best-quality studies of routine health care data to investigate whether first-contact physicians are putting back pain guidelines into practice (“usual care”).
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