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Werber A, Schiltenwolf M. Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality. Healthcare (Basel). 2016;4(3)doi: 10.3390/healthcare4030044.
Werber, A., & Schiltenwolf, M. (2016). Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality. Healthcare (Basel, Switzerland), 4(3), . https://doi.org/10.3390/healthcare4030044
Werber, Andreas, and Schiltenwolf, Marcus. "Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality." Healthcare (Basel, Switzerland) vol. 4,3 (2016). doi: https://doi.org/10.3390/healthcare4030044
Werber A, Schiltenwolf M. Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality. Healthcare (Basel). 2016 Jul 15;4(3). doi: 10.3390/healthcare4030044. PMID: 27417632; PMCID: PMC5041045.
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Healthcare (Basel). 2016 Jul 15;4(3). doi: 10.3390/healthcare4030044.

Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality.

Healthcare (Basel, Switzerland)

Andreas Werber, Marcus Schiltenwolf

Affiliations

  1. Department of Orthopedics and Orthopedic Surgery, University Hospital Giessen, Klinikstr. 33, 35392 Giessen, Germany. [email protected].
  2. Department of Orthopedics and Traumatology, University Hospital Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany. [email protected].

PMID: 27417632 PMCID: PMC5041045 DOI: 10.3390/healthcare4030044

Abstract

Despite the fact that unspecific low back pain is of important impact in general health care, this pain condition is often treated insufficiently. Poor efficiency has led to the necessity of guidelines addressing evidence-based strategies for treatment of lower back pain (LBP). We present some statements of the German medical care reality. Self-responsible action of the patient should be supported while invasive methods in particular should be avoided due to lacking evidence in outcome efficiency. However, it has to be stated that no effective implementation strategy has been established yet. Especially, studies on the economic impact of different implementation strategies are lacking. A lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population can be stated: persons with higher risk suffering from LBP by higher professional demands and lower educational level are not skilled in advised management of LBP. Both diagnostic imaging and invasive treatment methods increased dramatically leading to increased costs and doctor workload without being associated with improved patient functioning, severity of pain or overall health status due to the absence of a functioning primary care gate keeping system for patient selection. Opioids are prescribed on a grand scale and over a long period. Moreover, opioid prescription is not indicated properly, when predominantly persons with psychological distress like somatoform disorders are treated with opioids.

Keywords: guideline-based treatment; low back pain; somatisation

Conflict of interest statement

The authors declare no conflict of interest.

References

  1. Best Pract Res Clin Rheumatol. 2007 Feb;21(1):77-91 - PubMed
  2. Spine J. 2014 Oct 1;14(10):2299-319 - PubMed
  3. Spine (Phila Pa 1976). 1994 Sep 15;19(18 Suppl):2041S-2046S - PubMed
  4. Schmerz. 2015 Feb;29(1):109-30 - PubMed
  5. Orthopade. 2004 May;33(5):558-67 - PubMed
  6. J Am Board Fam Med. 2009 Jan-Feb;22(1):62-8 - PubMed
  7. BMJ. 2001 Jun 23;322(7301):1511-6 - PubMed
  8. Schmerz. 2009 Oct;23(5):440-7 - PubMed
  9. Pain Physician. 2014 May-Jun;17(3):217-26 - PubMed
  10. Pain. 2008 Mar;135(1-2):187-95 - PubMed
  11. Int Arch Occup Environ Health. 2005 May;78(4):253-69 - PubMed
  12. Lancet. 2007 Nov 10;370(9599):1638-43 - PubMed
  13. Pain Physician. 2015 May-Jun;18(3):E323-31 - PubMed
  14. Lancet. 2009 Feb 7;373(9662):463-72 - PubMed
  15. Eur J Pain. 2010 Sep;14(8):799-805 - PubMed
  16. Eur Spine J. 2007 Nov;16(11):1776-88 - PubMed
  17. Spine (Phila Pa 1976). 2005 Jul 1;30(13):1541-8; discussion 1549 - PubMed
  18. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007612 - PubMed
  19. Spine (Phila Pa 1976). 2009 May 1;34(10):1078-93 - PubMed
  20. Spine (Phila Pa 1976). 2009 May 1;34(10):1066-77 - PubMed
  21. Rheumatology (Oxford). 2009 May;48(5):520-7 - PubMed
  22. J Nerv Ment Dis. 2005 Feb;193(2):85-92 - PubMed
  23. MMW Fortschr Med. 2012 Jun 21;O 154 Suppl 2:39-43; quiz 44 - PubMed
  24. N Engl J Med. 2007 May 31;356(22):2239-43 - PubMed
  25. Spine (Phila Pa 1976). 2007 Apr 1;32(7):816-23 - PubMed

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