A recent article¹ in the journal PAIN provided an update on The Lancet Low Back Pain Series. This series, published in 2018, was a call to action to reduce low value care for low back pain. The 3 papers were written by 31 multi-disciplinary authors from 12 countries and sought to raise awareness of the disability caused by low back pain and the associated economic burden due to low value care.

Buchbinder R, Underwood M, Hartvigsen J, Maher CG. The Lancet Series call to action to reduce low value care for low back pain: an update. PAIN. 2020;161(Supplement 1):S57–S64. ↩︎

The Lancet published their Low Back Pain Series, a call to action reduce low value care for low back pain, in September, 2018. — The Lancet published their *Low Back Pain Series, a call to action reduce low value care for low back pain, in September, 2018.*

In September, four of the original authors, including Rachel Buchbinder, Martin Underwood, Jan Hartvigsen, and Chris Maher, published a follow-up article in The Journal of the International Association of Pain to highlight developments in the global effort to address spinal pain following The Lancet Low Back Pain Series.

The update emphasized that low back pain is still the leading cause of disability in the world - with 577 million people experiencing its effects at any given time - and contributes to a cycle of poverty and inequality. The authors also addressed the absence of high-quality, evidence-based, guideline-informed spinal care available to patients. The majority of global expenditure on healthcare for low back pain continues to be spent on low-value care, including "presentations to emergency departments, liberal use of diagnostic imaging, opioids, spinal injections, and surgery."

Positive news was also included in this update, including a variety of new and continued efforts to improve care and reduce spending. Among these are:

the Choosing Wisely campaign, an initiative of the ABIM Foundation.
the GLA:D® Back program, a treatment approach for patients with persistent or recurrent low back pain developed by researchers and clinicians at the University of Southern Denmark (SDU).
the E-SOLAS program¹ in Ireland, which trained physiotherapists to provide a group-based intervention for those experiencing persistent back pain.
and the FREE approach to management of low back pain, studied in New Zealand.²

The Global Spine Care Initiative was also included in this list of attempts to develop better system level and policy approaches to address low back pain. Due to the evidence that over treatment of low back pain can actually cause harm especially in underserved communities, Buchbinder, et al said, "it will be particularly important to determine the suitability of the model in low-income and middle-income settings and the involvement of local experts and communities will be crucial."

Scott Haldeman, DC, MD, PhD, the lead investigator of the Global Spine Care Initiative, stated, "It is really great to see the GSCI articles receive this level of recognition."

The GSCI was convened to build upon the work of World Spine Care, a multi-national charitable organization which has initiated spine care programs in partnership with governments of low- to middle-income countries. By developing an evidence-informed, practical, and sustainable spinal healthcare model that can be implemented anywhere, the GSCI seeks to further attain the World Spine Care vision of "a world in which everyone has access to the highest quality spine care possible."

References

1: Buchbinder R, Underwood M, Hartvigsen J, Maher CG. The Lancet Series call to action to reduce low value care for low back pain: an update. PAIN. 2020;161(Supplement 1):S57–S64.

2: Hurley DA, Keogh A, Mc Ardle D, Hall AM, Richmond H, Guerin S, Magdalinski T, Matthews J. Evaluation of an e-learning training program to support implementation of a group-based, theory-driven, self- management intervention for osteoarthritis and low-back pain: pre-post study. J Med Internet Res 2019;21:e11123.

3: Darlow B, Stanley J, Dean S, Abbott JH, Garrett S, Wilson R, Mathieson F, Dowell A. The Fear Reduction Exercised Early (FREE) approach to management of low back pain in general practice: a pragmatic cluster-randomised controlled trial. PLoS Med 2019;16:e1002897.

Hurley DA, Keogh A, Mc Ardle D, Hall AM, Richmond H, Guerin S, Magdalinski T, Matthews J. Evaluation of an e-learning training program to support implementation of a group-based, theory-driven, self- management intervention for osteoarthritis and low-back pain: pre-post study. J Med Internet Res 2019;21:e11123. ↩︎
Darlow B, Stanley J, Dean S, Abbott JH, Garrett S, Wilson R, Mathieson F, Dowell A. The Fear Reduction Exercised Early (FREE) approach to management of low back pain in general practice: a pragmatic cluster-randomised controlled trial. PLoS Med 2019;16:e1002897. ↩︎

Update to The Lancet Low Back Pain Series mentions Global Spine Care Initiative

References

Global Spine Care Initiative project published in European Spine Journal

GSCI article included in the top 17 cited articles in global neurosurgery

Global Spine Care Initiative