title: Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality.
abstract: Despite the fact that unspecific low back pain is of important impact in general health care, this pain condition is often treated insufficiently. Poor efficiency has led to the necessity of guidelines addressing evidence-based strategies for treatment of lower back pain (LBP). We present some statements of the German medical care reality. Self-responsible action of the patient should be supported while invasive methods in particular should be avoided due to lacking evidence in outcome efficiency. However, it has to be stated that no effective implementation strategy has been established yet. Especially, studies on the economic impact of different implementation strategies are lacking. A lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population can be stated: persons with higher risk suffering from LBP by higher professional demands and lower educational level are not skilled in advised management of LBP. Both diagnostic imaging and invasive treatment methods increased dramatically leading to increased costs and doctor workload without being associated with improved patient functioning, severity of pain or overall health status due to the absence of a functioning primary care gate keeping system for patient selection. Opioids are prescribed on a grand scale and over a long period. Moreover, opioid prescription is not indicated properly, when predominantly persons with psychological distress like somatoform disorders are treated with opioids.
authors.affiliation: Department of Orthopedics and Orthopedic Surgery, University Hospital Giessen, Klinikstr. 33, 35392 Giessen, Germany. andreas.werber@ortho.med.uni-giessen.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Werber
authors.affiliation: Department of Orthopedics and Traumatology, University Hospital Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany. marcus.schiltenwolf@med.uni-heidelberg.de.
authors.forename: Marcus
authors.initials: M
authors.lastname: Schiltenwolf
keywords: guideline-based treatment; low back pain; somatisation