Back problems

Pain is the main symptom of most back problems and treatment can be complex. This can be further complicated by comorbid conditions. Some general treatment strategies for chronic diseases, for example, lifestyle modifications such as diet, exercise, weight control, and reducing smoking, can benefit people with back problems (Bauer et al. 2014).

The most recent Australian clinical practice guidelines for management of non-specific low back pain encourages reassurance, self-management and physical therapy as first line care, supplemented by non-pharmacological therapies such as heat, massage, acupuncture and mindfulness where appropriate (Almeida et al. 2018). Medications are discouraged except where first and second-line non-pharmacological interventions are unsuccessful, and when they are prescribed, the lowest effective dose for the shortest amount of time possible is advised (Almeida et al. 2018).

Non-steroidal anti-inflammatory drugs (NSAIDS) should be the first-line medication when non-pharmacological management is inadequate (Almeida et al. 2018). Opioids should only be used when other treatments have failed after cautious assessment of risk versus benefits for the individual (Almeida et al. 2018). Paracetamol and surgery are no longer recommended (Almeida et al. 2018).

Reliable and up to date information on how to manage back pain is provided at mybackpain.org.au, a resource funded by Australia’s National Health and Medical Research Council, and developed by Arthritis Australia, the University of Queensland and Cochrane Back and Neck.

General practitioners and back pain treatment

General practitioners (GPs) are usually the first point of contact with the health care system for people with back problems. Back problems are among the most commonly managed conditions in general practice (Almeida et al. 2018). In 2015–16, 3.1 of every 100 GP-patient encounters for chronic conditions were for the management of back problems. This has increased significantly from 2.6 of every 100 GP-patient encounters in 2006–07 (Figure 1).

There is currently no nationally consistent primary health care data collection monitoring provision of care by GPs. The statistics on general practice activities are based on Bettering the Evaluation and Care of Health (BEACH) data, which are derived from a sample survey of GPs and their encounters with patients and should be interpreted with caution.

Figure 1: Rate of back complaints managed by GPs, 2006–07 to 2015–16

Source: Britt et al. 2016 (Data table).

Hospitalisation and the treatment of back problems

Data from the AIHW National Hospital Morbidity Database (NHMD) show that in 2017–18:

• there were 180,818 hospitalisations with a principal diagnosis of a back problem
• the rate of hospitalisations was greater for females than males (802 per 100,000 compared with 657 per 100,000)
• the rate of hospitalisation for back problems increased with age (Figure 2).

Figure 2: Rate of hospitalisation for back problems, by sex and age group, 2017–18

Source: AIHW National Hospital Morbidity Database (Data table).

The top 3 main reasons for back problem hospitalisations were:

• lower back pain (27% of hospitalisations for back problems)
• lumbar and other intervertebral disc disorders with radiculopathy (for example, when one or more nerve roots is affected and does not work properly) (10%)
• spinal stenosis (abnormal narrowing of the spinal canal that causes compression of the spinal cord) (8.6%).

From 2015–16 to 2017–18, the age-standardised hospitalisation rate for back problems among Australians remained relatively stable and was higher for females compared with males (Figure 3). Data prior to 2015–16 are not presented because rehabilitation hospitalisations were coded differently before this year.

Figure 3: Age-standardised rate of hospitalisations for back problems (principal diagnosis) by sex, 2015–16 to 2017–18

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Morbidity Database (Data table).