They May Resist Learning New Research-Based Approaches, Survey Suggests
Philadelphia, Pa. (May 15, 2009) – Primary care physicians with a “special interest” in managing back pain are actually less well-informed about the latest research-based evidence on back pain treatment, reports a study in the May 15 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
“These findings raise serious concerns about how back pain is currently being managed among general practitioners with a special interest in low back pain,” conclude Dr. Rachelle Buchbinder and colleagues of Monash University, Melbourne, Australia.
‘Special Interest’ Linked to Outdated Beliefs about Treating Back Pain
Nearly 4,000 Australian general practitioners completed a questionnaire regarding their knowledge and attitudes toward treating back pain. Sixteen percent of the doctors reported a special interest in back pain. However, physicians in this group scored lower in knowledge of the most recent evidence on back pain treatment. For example, 18 percent believed that patients with acute back pain should be placed on complete bed rest until the pain goes away, compared to nine percent of doctors without a special interest in back pain. Research has shown that bed rest does not improve the outcomes of acute back pain.
Physicians with a special interest in back pain were more likely to believe patients should not return to work until they are almost pain free. Studies have shown that work avoidance is unnecessary, and may even increase the risk of back pain becoming a chronic problem. Doctors in the special-interest group were also more likely to say that x-rays of the lower back are useful in patients with acute back pain—research suggests that x-rays usually don’t help in diagnosing back pain.
Implications for Doctors’ Continuing Education
Doctors who had recently taken a continuing medical education course on back pain were more knowledgeable about the latest research. Ironically, that was not the case for physicians with a special interest in back pain—they remained less well-informed than other physicians even if they had recently taken a course. Doctors reporting a special interest in occupational medicine were more knowledgeable about back pain, but those with a special interest in musculoskeletal medicine were not.
Current research suggests that the best advice for patients with back pain is to stay active and continue ordinary activities, including work. With this approach, the results are at least as good as with bed rest, early evaluation by a specialist, or x-rays or other tests. General practitioners and other primary care doctors don’t always follow evidence-based guidelines for managing back pain, however.
General practitioners reporting a special interest in back pain are actually less knowledgeable about the latest research-based treatments than other doctors, the new study suggests. Dr. Buchbinder and colleagues write, “The seeming inability to influence the interests of physicians with special interests in back pain raises the possibility that these beliefs may be recalcitrant to change”—perhaps because of “vested financial and/or professional interests.” New continuing medical education approaches may be needed to encourage primary care physicians to adopt evidence-based approaches to back pain.
About Spine
Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among general orthopaedic journals and subspecialty titles. Visit the journal website at www.spinejournal.com
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