General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines

Abstract

Objective-To compare general practitioners' reported management of acute back pain with "evidence based" guidelines for its management.Design-Confidential postal questionnaire. A minority performed manipulation (201/6) or acupuncture (6%). One third rated their satisfaction with management ofback pain as 4 out of 10 or less. Conclusions-The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting ofevidence. IntroductionBack pain is one of the commonest conditions managed in primary care, responsible each year for about 12 million general practitioner consultations, over 50 million work days lost, and almost £500m costs to the NHS.' Few management strategies for back pain have been proved in primary care, partly because most cases settle within a few weeks.2Given that most episodes of back pain settle with

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Guidelines for arthritis: ten years on

“…Guidelines can be used to improve the quality of care or to ration the use of expensive treatments. There have also been numerous recommendations on how guidelines should be produced 14 together with examples of problems in their implementation in routine practice; for example the difficulty in implementing guidelines for the management of back pain in primary care 15 . By contrast, setting criteria for embarking on a particular type of therapy or undertaking a specific procedure may be helpful in improving the overall standard of care.…”

Vocational rehabilitation of workers with back pain

“…Current guidelines, most of which have been recently introduced, aim at reducing the number of people with chronic pain and disability. Research shows that considerable change is needed to implement the guidelines fully (49,50), but also that the availability of recommended back pain services increased after the introduction of guidelines in the United Kingdom (51). Therefore, we can expect that, as guidelines become better implemented, the number of people with chronic pain and disability will decrease.…”