ARTICLE SUMMARY:
A controversial set of papers in The British Medical Journal challenging the efficacy of common interventions for chronic low back pain reflects glaring gaps in treatment of a condition that affects millions, but industry has yet to commit substantial resources to addressing the underlying problems.
In February, The British Medical Journal (The BMJ) published a set of papers concluding that current, common treatments for chronic low back pain (CLBP) are ineffective at providing pain relief compared with sham procedures.
The papers noted a lack of high-certainty evidence of a benefit for these interventions, and procedures supported by moderate or low certainty evidence showed little to no pain relief compared with sham procedures. These findings apply to subgroups of patients as well. Moreover, the authors said existing clinical guideline recommendations are inconsistent and conflicting.
The papers captured the attention of mainstream media, highlighting the enormous gap in clinical care for a condition that affects more than 16 million Americans annually, according to the Health Policy Institute at Georgetown University. Professional societies are pushing back, and while industry is largely complacent, the papers hold some takeaways for it as well.
Controversy over treatment of CLBP (lasting more than 3 months) isn’t new. Funding, skill sets, and interest in scientific innovation lags compared to other therapeutic areas, such as cardiac disease and cancer, in part because chronic low back pain is disabling but not life-threatening. (See “NASS 2024: Industry Is Healthy, Surgery as a Profession Under Strain,” MedTech Strategist, October 24, 2024.) Yet the consequences of under-treatment are serious. Patients’ desire for pain relief has been among the key drivers of the opioid epidemic in the US, according to the National Spine Health Foundation.
