IQWiG final report identifies recommendations for potential new DMP.
On 14 January 2016 the German Institute for Quality and Efficiency in Health Care (IQWiG) published the results of a search for evidence-based guidelines on the treatment of people with chronic back pain. The aim of the report is to identify those recommendations from current guidelines of high methodological quality that may be relevant for the potential new disease management programme (DMP) "Chronic back pain". According to the results of the report the recommendations cover all important health care aspects and are largely consistent.
A total of 6 guidelines includedThe 6 guidelines that IQWiG could include and analyse cover all important aspects of diagnosis, treatment, and relapse prevention.
In the diagnosis of patients with back pain it is primarily important to identify those risk factors that could lead to chronic disease. The guidelines address the standardized documentation of symptoms and psychosocial risk factors, as well as imaging procedures, blood tests, and the use of diagnostic nerve blocks.
Recommendations are largely consistentBesides drug and invasive therapy (e.g. injections in joints), many non-drug interventions are mentioned. In addition to massages, manual therapy, physical activity, physiotherapy, and yoga, these also include behavioural therapy. It is noticeable that the guideline authors commonly advise against certain interventions. This concerns, for example, massages, bed rest, transcutaneous electrical nerve stimulation (TENS) or therapeutic ultrasound.
The recommendations are largely consistent. Inconsistencies only exist with regard to drug therapy (with paracetamol and phytotherapeutics), acupuncture, and discography (a radiographic diagnostic procedure to depict the intervertebral disc).