Understanding Why Your Doctor's Advice on Lower Back Pain May Not Be the Best

Managing lower back pain involves complex considerations, and recent insights suggest that the guidance provided by healthcare professionals might not always align with the latest evidence or optimal treatment strategies. Lower back pain is exceedingly costly to treat, with estimates indicating that in the UK alone, the NHS spends around £3.2 billion annually. Therefore, delivering accurate and up-to-date advice is crucial for effective care.

The UK's National Institute for Health and Care Excellence (NICE) last updated its guidance on lower back pain in 2020. Since medical knowledge evolves rapidly, some recommendations may now be outdated, leading to suboptimal patient outcomes.

Most individuals with lower back pain recover quickly without intervention. However, a minority develop chronic issues, which can result in long-term disability. Typically, affected patients first consult their general practitioners (GPs). Depending on the case, GPs may refer patients to physical therapists or, in some regions, patients can self-refer.

NICE recommends employing a brief questionnaire to identify those at risk of prolonged pain, allowing for targeted, more intensive treatment for high-risk patients. Conversely, low-risk individuals are usually advised on self-care and provided with information to manage their recovery independently.

While initial studies supported this risk-based approach, subsequent research has challenged its efficacy, revealing that targeting care may not significantly improve recovery compared to offering standard physical therapy to everyone.

Self-management strategies, including providing information and empowering patients to control their recovery, are also recommended. Nonetheless, recent studies indicate that online support programs might not offer additional benefits over usual GP-led care.

For patients experiencing persistent lower back pain—lasting three months or more—NICE suggests considering radiofrequency denervation, a procedure targeting nerve signals that transmit pain. Although some research indicates potential benefits, other studies show no significant improvement, underscoring the need for caution and further investigation.

Regarding medication, NICE advises against opioids for short-term back pain due to limited evidence of benefit and potential harm. Weak opioids like codeine may sometimes be used when anti-inflammatory drugs are contraindicated or ineffective. However, stronger opioids have not demonstrated efficacy, and recent research advocates for more explicit guidance discouraging their use.

Instead, treatments with clearer evidence of effectiveness include non-steroidal anti-inflammatory drugs such as ibuprofen and heat therapy devices like hot packs. These options often provide relief in acute cases.

For persistent lower back pain, evidence supports the role of regular exercise, with studies showing benefits from activities like walking in preventing flare-ups. Additionally, approaches like cognitive functional therapy—which addresses psychological barriers—and mindfulness meditation have demonstrated promising, long-lasting results.

Furthermore, alternative therapies endorsed by global health authorities, such as manual therapy and acupuncture, can be beneficial for ongoing symptoms. Overall, current guidelines may not always reflect these evolving insights, and healthcare providers should consider the latest evidence to improve patient outcomes.

Source: https://medicalxpress.com/news/2025-06-doctor-advice-pain.html