Clinicians should avoid 'treatment by default' for patients with back pain

A physiotherapist has urged clinicians to avoid “treatment by default” for patients with back pain and consider doing nothing.

Lucy Jones, who is based at Southampton General Hospital, said many patients simply want to know why they have pain and receive reassurance it is “not anything sinister” before they commit to treatment.

But clinicians often fail to discuss the option of no intervention due to “paternalism” and, as a result, patients embark on unwanted exercise or other therapy programmes.

Ms Jones spoke out after completing the UK’s first study into how involved patients are in the decisions made with therapists about their care.

“While clinicians may have altruistic motives and a strong desire to treat, it is important at every stage to consider whether including ‘no treatment’ is a valid option and avoid the temptation to offer treatment by default,” she explained.

“Often patients just want an explanation regarding why they have pain and reassurance the problem is not caused by anything sinister, so the ‘wait and see’ should be given much greater consideration provided they have been properly and appropriately assessed.”

The research, funded by Arthritis Research UK and presented at the international Society for Back Pain Research conference, found that out of 80 observed appointments, the choice to defer treatment was provided in only two appointments and the option of taking no action considered just once.

Back pain affects more than 1.1 million people in the UK, with 95% of patients suffering from problems affecting the lower back, and costs the NHS more than £1 billion a year, including £150 million on physiotherapy.

Although therapists can offer patients a range of immediate interventions, including exercise plans, manual therapy or acupuncture, these can prove futile if decisions about treatment have not been made together.

“Shared decision-making is vital because success of the treatment is very dependent on active involvement of both patient and therapist,” said Ms Jones, who carried out the study alongside Dr Lisa Roberts, a consultant physiotherapist and senior lecturer, and received the Society for Back Pain Research's new investigator award for its relevance and quality.

Dr Roberts added: “In an environment where the ‘right’ treatment decision depends upon balancing the benefits, risks and likely outcomes against the preferences, needs and values of the individual, it is essential all options – including no treatment – are explored as a general rule.”

Posted on Friday 28 March 2014

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