Study Finds Physicians Do Not Consistently Follow Back Pain Guidelines

In a study published at Practical Pain Management, a survey of primary care physicians across 5 hospitals revealed that nonspecific back pain is inconsistently managed.

The study, conducted by students at Touro University, across an even spread of male and female physicians in New York City, posed a hypothetical question: how would you treat a patient presenting with acute, nonspecific back pain? Although some cases require specific treatment plans and specialist referrals, the results of the study show that nonspecific back pain may be handled differently by different physicians. This is done, according to the publication, despite the existence of several guidelines that offer courses of self-managed care and less “medicalized” options for initial treatment.

If a patient needs some pain relief, doctors should advise safe over-the-counter solutions, such as acetaminophen or a non-steroidal anti-inflammatory drug (NSAID), like aspirin or ibuprofen. If the pain persists, patients could try out some kind of secondary treatment, like spinal manipulation, acupuncture, yoga, or massage therapy, but these aren’t the first line of defense, noted the investigators.

The study also focused on some analysis of physician recommendations by gender, and found some interesting results:

• Male doctors were 10 times more likely to refer the patient to an orthopedist
• Male doctors were 2.5 times more likely to refer to a physiatrist, or physical therapist.
• Female doctors were more likely to prescribe medications (like muscle relaxants), thermal treatments, and spinal manipulation.
• Female doctors were also more likely to prescribe x-rays or CT scans.

The conversation around this subject is nuanced, and, as a commentator on the publication’s website noted, “I’m sure there are lots of reasons [why], but I think it’s a function of habit.”