On the basis of the suffering seen in the daily practice of the orthopedic surgeon, I believe it is important to expand and summarize by once again placing particular emphasis on the following points:
Acute unspecific back pain is a bothersome but harmless everyday problem with a good prognosis for self-limitation. In the first instance it does not require any specialized medical diagnosis or treatment. Provided red flags have been ruled out, clinical examination and initial treatment by a primary care physician are sufficient for the first 3 to 6 weeks.
For initial treatment, neither cortisone or other injections, nor deep lumbar infiltrations, nor massages or similar are indicated, even if they are readily demanded by patients and their “advisers.” Given the high spontaneous cure rate of the complaints, I find lavish, expensive IGeL items for the treatment of acute unspecific back pain dubious. Simple back taping does the same job as expensive machines.
Unspecific back pain that recurs more frequently should be a sign to patients that something in their lives needs to change. This generally means more exercise and less stress. Unfortunately, patients have to do this themselves and break out of their comfort zone and dysfunctional behavioral patterns. Regrettably, when advising their patients in this regard, not all physicians follow guidelines.
I would very much welcome it if other opinion-formers, such as health insurers, schools, employers, consumer advice centers, etc., made even greater efforts towards preventing these problems.
References
- 1.Casser HR, Seddigh S, Rauschmann M. Acute lumbar back pain—investigation, differential diagnosis and treatment. Dtsch Arztebl Int. 2016;113:223–234. doi: 10.3238/arztebl.2016.0223. [DOI] [PMC free article] [PubMed] [Google Scholar]