Search

Introduction Low back pain is the single biggest cause of years lived with disability worldwide, and a major challenge to international health systems. (1) In 2018, the Lancet Low Back [...], back pain is the leading cause of years lived with disability globally. In 2018, an international working group called on the World Health Organization to increase attention on the burden of low back pain and the need to avoid excessively medical solutions. Indeed, major international clinical guidelines now recognize that many people with low back pain require little or no formal treatment. Where treatment is required the recommended approach is to discourage use of pain medication, steroid injections and spinal surgery, and instead promote physical and psychological therapies. Many health systems are not designed to support this approach. In this paper we discuss why care for low back pain that is concordant with guidelines requires system-wide changes. We detail the key challenges of low back pain care within health systems. These include the financial interests of pharmaceutical and other companies; outdated payment systems that favour medical care over patients' self-management; and deep-rooted medical traditions and beliefs about care for back pain among physicians and the public. We give international examples of promising solutions and policies and practices for health systems facing an increasing burden of ineffective care for low back pain. We suggest policies that, by shifting resources from unnecessary care to guideline-concordant care for low back pain, could be cost-neutral and have widespread impact. Small adjustments to health policy will not work in isolation, however. Workplace systems, legal frameworks, personal beliefs, politics and the overall societal context in which we experience health, will also need to change. Les lombalgies sont la principale cause d'annees de vie vecues avec une incapacite dans le monde. En 2018, un groupe de travail international a invite l'Organisation mondiale de la Sante a attirer l'attention sur la charge que representent les lombalgies et sur la necessite d'eviter le recours excessif aux solutions medicales. En effet, selon les dernieres recommandations cliniques internationales, de nombreux cas de lombalgie ne necessitent pas ou peu de traitement formel. Lorsqu'un traitement est requis, il est recommande de limiter la prise d'analgesiques, les injections de steroides et la chirurgie rachidienne, et d'encourager plutot les therapeutiques physiques et psychologiques. Tres souvent, les systemes de sante ne sont pas concus pour appliquer cette approche. Dans cet article, nous abordons les raisons pour lesquelles un changement des systemes s'impose si l'on veut prendre en charge les lombalgies suivant les recommandations. Nous detaillons les principales difficultes de la prise en charge des lombalgies dans le cadre des systemes de sante. Il s'agit notamment des interets financiers des laboratoires pharmaceutiques, entre autres; des systemes de paiement obsoletes qui privilegient la prise en charge medicale a l'autogestion par les patients; et de croyances et traditions medicales profondement ancrees parmi les medecins et la population. Nous donnons des exemples internationaux de solutions, de politiques et de pratiques prometteuses pour les systemes de sante confrontes de plus en plus souvent a une prise en charge inefficace des lombalgies. Nous suggerons des politiques qui, sans incidence sur les couts, en transferant les ressources allouees aux soins inutiles vers des soins conformes aux recommandations, pourraient avoir un impact considerable. De petits ajustements des politiques de sante ne suffiront cependant pas. Les systemes des milieux professionnels, les cadres juridiques, les croyances personnelles, les politiques et le contexte societal global dans lequel s'inscrit la sante devront egalement changer. El dolor lumbar es la causa principal de vivir con discapacidad durante anos en todo el mundo. En 2018, un grupo de trabajo internacional pidio a la Organizacion Mundial de la Salud que prestara mas atencion a la carga del dolor lumbar y a la necesidad de evitar soluciones excesivamente medicas. De hecho, las principales directrices clinicas internacionales reconocen ahora que muchas personas con dolor lumbar requieren poco o ningun tratamiento formal. Cuando se requiere tratamiento, el enfoque recomendado es desalentar el uso de analgesicos, inyecciones de esteroides y cirugia de la columna vertebral y, en su lugar, promover las terapias fisicas y psicologicas. Muchos sistemas de salud no estan disenados para apoyar este enfoque. En este documento, se expone por que el cuidado del dolor lumbar de acuerdo con las directrices requiere cambios en todo el sistema. Se detallan los retos clave de la atencion del dolor lumbar en los sistemas de salud. Estos incluyen los intereses financieros de las companias farmaceuticas y de otro tipo, los sistemas de pago obsoletos que favorecen la atencion medica por encima del autocuidado de los pacientes, asi como las tradiciones y las creencias medicas profundamente arraigadas sobre la atencion del dolor de espalda entre los medicos y el publico general. Se presentan ejemplos internacionales de soluciones prometedoras y de politicas y practicas para los sistemas de salud que se enfrentan a una carga cada vez mayor de la atencion ineficaz para el dolor lumbar. Se sugieren politicas que, al desplazar los recursos de la atencion innecesaria a la atencion acorde con las directrices para el dolor lumbar, podrian ser neutras en cuanto a costes y tener un impacto generalizado. Sin embargo, los pequenos ajustes en la politica sanitaria no funcionaran de forma aislada. Los sistemas del lugar de trabajo, los marcos juridicos, las creencias personales, la politica y el contexto social general en el que vivimos la salud tambien tendran que cambiar.

OBJECTIVE: To estimate the difference in confidence to become active despite low back pain in people who were exposed to one of 2 video interventions delivered on social media, compared to no intervention. DESIGN: A proof-of-concept, 3-group randomized controlled trial, in a 1:1:1 ratio. METHODS: Participants aged 18 years and over, with and without low back pain, were recruited via the social media channel Facebook, to view either a humorous video, a neutral video, or to no intervention. The videos were delivered online, explained evidence-based management for low back pain, and were designed to "go viral." The primary outcome was confidence in becoming active despite pain, measured using the Pain Self Efficacy Questionnaire (Item 10) (ranges from 0 [not at all confident] to 6 [completely confident]) immediately after watching the video. We aimed to capture the real-time impact and immediate reactions that contributed to the content's reach. RESULTS: Among 1933 randomized participants (mean [standard deviation] age: 58.9 [14.0] years, 1285 [75%] women), 1232 [70%] had low back pain and 88.8% completed the primary outcome. One thousand two hundred sixty-four participants were randomized to receive a video intervention, and 633 participants did not receive a video. On a 6-point scale, individuals exposed to either video (n = 1088) showed a mean confidence level 0.3 points higher (95% confidence interval: 0.1, 0.6) compared with no video (n = 630). CONCLUSION: Participants who viewed a brief video intervention reported a very small difference in confidence to become active despite low back pain, compared with no intervention. The difference may lack clinical relevance. [ABSTRACT FROM AUTHOR]

Introduction: The increasing number of gabapentinoid (pregabalin and gabapentin) harms, including deaths observed across countries is concerning to health‐care professionals and policy makers. However, it is unclear if the public shares these concerns. This study aimed to describe posts related to gabapentinoids, conduct a content analysis to identify common themes and describe adverse events or symptoms. Methods: Keywords of 'pregabalin' or 'Lyrica' or 'gabapentin' or 'Neurontin' were used to search for related tweets posted by people in the community between 8 March and 7 May 2021. Eligible tweets included a keyword in the post. We extracted de‐identified data which included descriptive data of the total number of posts over time; and data on individual tweets including date, number of re‐tweets and post content. Data were exported separately for pregabalin‐ and gabapentin‐related tweets. A 20% random sample was used for the thematic analysis. Results: There were 2931 pregabalin‐related tweets and 2736 gabapentin‐related tweets. Thematic analysis revealed three themes (sharing positive experiences and benefits of taking gabapentinoids, people voicing their negative experiences, and people seeking opinions and sharing information). Positive experiences of gabapentinoids were related to sharing stories and giving advice. This was contrasted to negative experiences including ineffectiveness, withdrawals, side effects and frustration related to cost and insurance coverage. Brain fog was the most common adverse symptom reported. Gabapentinoid‐related deaths were only mentioned in three tweets. Discussion: The increasing public health concern of gabapentinoid‐related deaths was not translated to Twitter discussions. [ABSTRACT FROM AUTHOR]