According to national guidelines, the best care for acute lower back pain is simple: stay active, avoid bed rest and take regular simple analgesics such as paracetamol.

However new research from the University of Sydney and three University-affiliated research institutes has found that only 20 per cent of patients receive this simple treatment approach.

Researchers from the Faculties of Pharmacy, Medicine and Health Sciences at the University of Sydney have collaborated on the survey investigating how Australian GPs manage acute lower back pain (LBP).

Led by researchers at the George Institute for International Health, the study has found that the key aspects of 'usual care' provided by GPs to patients with LBP does not match international evidence-based guidelines.

The survey found that in 'usual care' nearly two thirds of patients received a medication for a new LBP problem. Grouping of these medications revealed a pattern contrary to recommendations contained in most international guidelines.

International guidelines also suggest GPs provide patients with advice, education and reassurance of a favourable prognosis, whereas only one fifth of patients surveyed were provided with this information. While guidelines also caution against the use of imaging, it had been requested for just over a quarter of all patients surveyed.

According to the researchers, understanding why GPs do not follow key treatment recommendations of guidelines is an important prerequisite to improving this situation.

Ultimately the research shows that more and better communication strategies are needed to bring about a change in practice with regard to new treatment guidelines says Professor Andrew McLachlan of the Faculty of Pharmacy.

The study takes into account that guidelines are for general treatment practices, but also recognises that clinicians will still need to diverge from these for some individual patients as required.

The research group used data taken from the Bettering of Evaluation and Care of Health (BEACH) study, which is a continuous national study of general practice activities in Australia that began in 1998.

To date, the BEACH study has involved about half of all practising GPs in the country and provided the research group with a large and representative data set. Analyses was based on prospectively recorded management data from 3,533 encounters in which patients sought care for new LBP from more than 2,000 GPs in the community.

Researchers involved in the study include Professor Chris Maher, Christopher Williams and Dr Jane Latimer from The George Institute, Dr Mark Hancock and Dr James McAuley from the Back Pain Research Group at the University of Sydney's Faculty of Health Science and Associate Professor Helena Britt from the Family Medicine Research Centre at the University of Sydney's Faculty of Medicine.

The full paper has been published in the February 8th issue of Archives of Internal Medicine, one of the Journal of American Medical Association Archive Journals.

Media inquiries: Kath Kenny 0434 606 100, kath.kenny@sydney.edu.au

Medicine