This is the third paper in the Lancet Low Back Pain Series, written as a call to action for policy makers and clinicians. It argues that most low back pain is non-specific and that current care is often over-medicalised, wasteful, and harmful. It proposes the 'positive health' model and stricter regulation of tests and treatments as the path forward.
When a patient presents with non-specific low back pain, the highest-value moves are reassurance, encouragement to stay active, and avoidance of unnecessary imaging. MRI frequently shows degenerative changes that are incidental. Attributing symptoms to those findings drives a cascade of low-value care and can worsen disability.
This paper frames disabling low back pain as partly iatrogenic — passive treatments, opioids, and over-investigation entrench the problem rather than fix it. The US opioid epidemic is cited as the cautionary example. The practical model is 'positive health': help patients adapt and self-manage instead of chasing a cure. Steer them toward exercise and early return to work.
The authors also argue that tests and non-drug procedures should be held to the same evidence bar as drugs, using the removal of radiofrequency denervation from Dutch coverage as a concrete example.
This is the third paper in the Lancet Low Back Pain Series, written as a call to action for policy makers and clinicians. It argues that most low back pain is non-specific and that current care is often over-medicalised, wasteful, and harmful. It proposes the 'positive health' model and stricter regulation of tests and treatments as the path forward.
When a patient presents with non-specific low back pain, the highest-value moves are reassurance, encouragement to stay active, and avoidance of unnecessary imaging. MRI frequently shows degenerative changes that are incidental. Attributing symptoms to those findings drives a cascade of low-value care and can worsen disability.
This paper frames disabling low back pain as partly iatrogenic — passive treatments, opioids, and over-investigation entrench the problem rather than fix it. The US opioid epidemic is cited as the cautionary example. The practical model is 'positive health': help patients adapt and self-manage instead of chasing a cure. Steer them toward exercise and early return to work.
The authors also argue that tests and non-drug procedures should be held to the same evidence bar as drugs, using the removal of radiofrequency denervation from Dutch coverage as a concrete example.