Ten-year survey reveals differences in GP management of neck and back pain

Abstract

Purpose Clinical guidelines provide similar recommendations for the management of new neck pain and low back pain (LBP) but it is unclear if general practitioner's (GP) care is similar. While GP's management of LBP is well documented, little is known about GP's management of neck pain. We aimed to describe GP's management of new neck pain and compare this to GP's management of new LBP in Australia between April 2000 and March 2010. Methods All GP-patient encounters for a new (i.e. first visit to any medical practitioner) neck pain or LBP problem were compared in terms of treatment delivered, referral patterns and requests for laboratory and imaging investigations. Results General practitioners in Australia have managed new neck pain and LBP problems at a rate of 3.1 and 5.8 per 1,000 GP-patient encounters, respectively. GP's primarily utilised medications, in particular non-steroidal anti-inflammatory drugs, to manage new neck and LBP problems and referred approximately 25% of all patients for imaging. Patients with new neck pain are more frequently managed using physical treatments and were referred more often to allied health professionals and specialists. In comparison, patients with new LBP were managed more frequently with medication, advice, provision of a sickness certificate and ordering of pathology tests. Conclusions This is the first time GP management of a new episode of neck pain has been documented using a nationally representative sample and it is also the first time that the management of back and neck pain has been compared. Despite guidelines endorsing a similar approach for the management of new neck pain and LBP, in actual clinical practice Australian GPs manage these two conditions differently.

Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data

“…Our study found less than half of new consulters for musculoskeletal pain received an analgesic. A previous study of those aged over 50 consulting in primary care for musculoskeletal pain, and who had not consulted in the previous 30 days, also reported that less than half were prescribed analgesics [ 17 ] and this is also similar to findings from studies focussed on neck and back pain [ 6 , 7 ] and on osteoarthritis [ 18 ]. It is feasible that GPs may be following guidelines that recommend the early use of exercise and other physical therapies with or without analgesia and further research is needed to determine if this is happening [ 1 , 19 ].…”

“…Despite guidance advocating similar approaches for neck and low back pain, their management strategies have been shown to be different in terms of the analgesics prescribed and other therapies [ 6 ]. Whilst even with the introduction of guidelines, analgesic prescribing in patients with low back pain has not been shown to change [ 7 ].…”

Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis

“…Spinal pain (neck or low back pain) is the leading cause of disability worldwide,1 2 and commonly managed in general practice by prescription of medicines 3 4. Clinical guidelines recommend non-steroidal anti-inflammatory drugs (NSAIDs) as a second-line analgesic after paracetamol, with third choice being opioids 5.…”

Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury

“…The authors support the value of these well-established and expert-derived guidelines that imaging is appropriately not recommended for the majority of patients with spinal pain. However, despite the proposed benefits of following the guidelines (cost-savings, reductions in exposure to ionizing radiation, avoiding the identification of pathology that may simply represent normal variants, and potentially misinforming clinical decision making), adherence to guidelines is quite variable [36–38], and it is largely unknown if adherence results in improved outcomes. Furthermore, there remains a lack of a gold standard quantitative metric for diagnosing low back and neck pain.…”