Surgeons and family physicians not up-to-date with low back pain guidelines

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Both orthopaedic surgeons’ and family physicians’ knowledge of treating low back pain (LBP) is deficient, said researchers who performed a comparative knowledge survey which was published in the July issue of Spine.

Investigators compared the knowledge of orthopaedic surgeons and family practitioners in managing simple low back pain with reference to currently published guidelines and found that most orthopaedists would send their patients for radiologic evaluations and also preferentially prescribe cyclo-oxygenase-2-specific nonsteroidal anti-inflammatory drugs. This goes against the guidelines which do not recommend immediate radiologic evaluation and which recommend use of paracetamol or nonspecific nonsteroidal anti-inflammatory drugs.


Low back pain is the most prevalent of musculoskeletal conditions affecting nearly everyone at some point in time. Researchers said that treatment guidelines for LBP should be based on evidence-based medicine and updated to improve patient management and outcome. “Studies in various fields have assessed the impact of publishing guidelines on patient management, but little is known about the physicians’ knowledge of the guidelines,” they noted.


The study involved orthopedic surgeons and family practitioners participating in their annual professional meetings answering a questionnaire regarding the management of simple low back pain. Answers were scored based on the national guidelines for management of low back pain.

Results of the study showed that 140 family practitioners and 253 orthopaedists responded to the questionnaire. The mean family practitioners’ score (69.7) was significantly higher than the orthopaedists’ score (44.3) (P < 0.0001). No relationship was found between the results and physician demographic factors, including seniority.


Investigators concluded that orthopedic surgeons are less aware of current treatment than family practitioners. Although the importance of publishing guidelines and keeping them up-to-date and relevant for different disciplines in different countries cannot be overstressed, disseminating the knowledge to clinicians is also very important to ensure good practice.