Exercise is not being used enough to treat low back and neck pain
Research Activities, October 2009
Chronic low back and neck pain are common in the United States, resulting in lost work productivity, increased health care costs, and disability. Various treatments, such as exercise and back rehabilitation programs, have been shown to be effective at treating these conditions. Yet, two new studies show that physicians rely too much on prescribing narcotics and not enough on prescribing specific exercises to treat back and neck pain. In the first study, exercise was underutilized as a treatment for chronic low back and neck pain. In the second study, focusing on back pain, most providers offered patients narcotics for pain relief. Both studies, supported in part by the Agency for Healthcare Research and Quality (T32 HS00032), are summarized here.
Freburger, J. K, Carey, T. S., Holmes, G. M., and others (2009, February). "Exercise prescription for chronic back or neck pain: Who prescribes it? Who gets it? What is prescribed?" Arthritis & Rheumatism 61(2), pp. 192-200.
In this study, researchers conducted a telephone survey of 684 individuals suffering from chronic low back or neck pain. All had seen a health care provider for the condition during the past 12 months. During the survey, they were asked about receiving a prescription for exercise, the type of activity, its frequency and length, and the degree of supervision. Less than half of those surveyed (48 percent) were prescribed exercise. Among those who did receive an exercise prescription, 46 percent had it prescribed by a physical therapist, 29 percent by a physician, and 21 percent by a chiropractor. Treatment by physical therapists or chiropractors was the strongest predictor of getting an exercise prescription. Patients most likely to get such a prescription were female, highly educated, and receiving workers' compensation. Compared with physicians and chiropractors, physical therapists were more likely to supervise the exercise program and prescribe strengthening and stretching exercises.
Carey, T. S., Freburger, J. K., Holmes, G. M., and others (2009). "A long way to go: Practice patterns and evidence in chronic low back pain care." Spine 34, pp. 718-724.
In this study, 706 individuals with chronic low back pain were also surveyed by telephone. The vast majority (84 percent) had at least one visit to a health care provider. Most were middle aged; 62 percent were women. The researchers found that 60 percent of those interviewed had used narcotics in the past month. More than one-third of the individuals had undergone some sort of advanced imaging procedure in the past year. Although participants had received various treatments from physicians during numerous visits, such interventions were not supported by the evidence. For example, a mere 3 percent had participated in a formal spine rehabilitation program. Untreated depression was also common. Half of patients not already taking antidepressants scored positive on a two-item depression screen. The researchers conclude that current treatment patterns for low back pain are consistent with overuse of some medications and treatments and underuse of exercise and depression treatment.