Male doctors treat low back pain differently than female doctors do - and neither gender follows recommended guidelines for treating this common and costly health problem, according to new findings presented at a poster session at Touro College Research Day on April 28, 2015.
"Male physicians were more likely to refer, and pain relief was more likely to be recommended by female physicians," says Shira Schechter Weiner, PhD, an associate professor in the Doctor of Physical Therapy Program at Touro College's School of Health Sciences and the lead author of the new study. "Most recommendations were outside of the guidelines, based on the case that was presented."
Eight in 10 adults will have low back pain at some point in their lives, according to the National Institute of Neurological Disorders and Stroke. Low back pain will become chronic - meaning it lasts longer than 12 weeks - in 20% of these individuals. Appropriate treatment of shorter-term back pain is crucial to prevent it from becoming chronic, Dr. Weiner said.
Current guidelines from the American College of Physicians and the American Pain Society for treating acute low back pain include offering information and reassurance, recommending over-the-counter medication, and providing manipulation of the affected part of the back, which can be done by physical therapists or chiropractors, Dr. Weiner explained. However, she added, these guidelines are often not followed.
As part of a larger study investigating why doctors don't follow low back pain treatment guidelines, Dr. Weiner and her colleagues looked at whether a physician's gender influenced the type of treatment they recommended. They surveyed 284 primary care doctors, randomly sampled from five leading New York City hospitals, on how they would treat a hypothetical case of acute low back pain.
Male physicians were 10 times more likely than female doctors to say they would refer the patient to an orthopedist, and 2.5 times as likely to refer to a physiatrist, neither of which are recommended by evidence-based guidelines.
Female doctors were more likely to recommend pain relief, including muscle relaxants and thermal treatments (both against guidelines), while they were also more likely to recommend manipulation to relieve pain. Women physicians were also more likely to recommend computed tomography scans for the patient, against guidelines.
"Low back pain is a very large and costly problem," Dr. Weiner said. "We have many guidelines that can help us understand how to manage this common problem, in an effort to optimize the outcome for the patient in the least expensive way possible, and the guidelines are not being followed as they should be."
"We need to all focus on preventing chronicity in these patients, and be committed to providing the best evidence-based care that has been shown to achieve that goal," she added. "If we do the wrong thing the patient's more likely to become chronic, so we have to find ways to help clinicians do the right thing, because it's been shown to improve outcomes for patients."