Doctors urged to prescribe yoga, mindfulness not drugs to fight lower back pain

Louisa O’Neill will never forget the first time she could kick a footy with her son. He was six. Until then, she had been in too much pain. 

Since slipping while running to catch a train as a 16-year-old, the Mornington mother has suffered chronic pain in her lower back. 

“It’s a silent illness,” she said. “No one can see your pain.”

Ms O’Neill is not alone.

According to a team of Australian academics, lower back pain is the leading cause of disability worldwide and the second most common reason for seeking care from a family doctor after the common cold.

In Australia, it is the number-one cause of early retirement.

A University of Sydney review into lower back pain diagnosis and treatment published on Monday said GPs should suggest non-medicinal approaches to help alleviate the pain of people like Ms O’Neill. 

The paper found “overwhelming amount of research” showing most pain medicines had little to no effect compared to placebos in treating lower back pain – or LBP – and that international guidelines had radically changed in response to an escalating prescription opioid crisis.

Lead author Dr Adrian Traeger said doctors should recommend treatments such as yoga, mindfulness and various types of physiotherapy and psychological therapies over painkillers. 

But Dr Traeger said Medicare needed to catch up to changing best practice.

He said he was concerned that, without support from Medicare, the suggested reforms could place additional financial strain on those suffering from LBP.

“Health systems in most industrialised countries, including Australian Medicare, are simply not set up to fund the care that is considered the most appropriate for lower back pain right now,” Dr Traeger said.

“However, if Medicare were to make simple changes to improve affordability of alternatives to pain medicines, not only would it make a GP’s job easier, it could result in a major impact on the lives of many living with low back pain, including those who rely on opioids.”

But not everyone in the Australian medical community is convinced. 

Australian Medical Association vice-president Dr Tony Bartone said more evidence was needed before putting public funds into alternative treatments. 

He described meditation as a “second or third line” measure in some instances of lower back pain and said the AMA would support other forms of alternative treatments “when and if” clinical guidelines endorsed them.

Dr Bartone said clinical guidelines for LBP were proven, and that mild painkillers and supportive care were the way to go. 

But he, too, warned against reliance on heavy-duty painkillers. 

“Opioids are very strong pain relief medication and have a huge capacity for dependency so, obviously, they need be used judiciously and sparingly and only in appropriate cases after other measure failed”.

For Ms O’Neill, both painkillers and more holistic pain relief have their place.  

After three decades of chronic pain she knows the dangers of reliance on opioids and is conscious only to take one painkiller a day. 

She said she was concerned that “scaremongering” about opioids and blanket changes to treatments could prevent sufferers of chronic pain from getting the relief they needed. 

“Pain is a silent issue that many many people suffer,” she said. 

“People can’t judge others people’s pain – and they need be aware their judgments hurt.” 

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