Physiotherapy compared with advice for low back pain

Editor—As a qualified physiotherapist with postgraduate training in manipulative therapy, I believe that physiotherapists, chiropractors, and osteopaths should stop squabbling and appreciate that each discipline is valuable in its own right.¹,²

The study by Frost et al comparing physiotherapy with advice for low back pain confirms what most therapists already know: it is extremely difficult to effectively manage chronic low back pain.³ In the study 77% of patients would be categorised as having chronic back pain, 35% of them having had pain for a year or more.

NHS physiotherapists are often frustrated trying to help this group of patients. General practitioners commonly manage early back pain with advice, exercises, analgesia, and non-steroidal anti-inflammatory drugs. If this approach fails the next step is usually referral to a physiotherapist, chiropractor, or osteopath. If this treatment fails to “cure” the problem, what then? Consultants are rightly reluctant to intervene in all but the most severe cases of back pain, the wait to see a consultant adding to the likelihood of chronic problems developing. The patient often ends up in a loop of repeat referrals for further ineffective treatment.

Several respondents have identified the need to encourage a more self oriented approach to management of chronic back pain.¹,² Socioeconomic, emotional, and cognitive factors are now known to have a huge influence on chronic pain, with increasing realisation of the value of expert patient and chronic pain management programmes to empower patients to manage their chronic pain. Access to clinical psychologists has been a huge advantage in this area.

Frost et al simply support this type of management approach. Constant referrals for physical hands-on treatment are not the way to manage chronic low back pain—biopsychosocial approaches are.