Amsterdam UMC researchers, among others APH researcher Pieter Coenen (Research Associate, Public and occupational health), studied 5 treatments for people with back pain whose effectiveness has not been proven:
- bed rest for non-specific back pain;
- bed rest for a herniated disc;
- discectomy for spinal stenosis, the (partial) removal of an intervertebral disc in case of a narrowing of the spinal canal;
- fusion, the surgical joining of vertebrae;
- invasive pain treatments, such as injecting pain medication.
The researchers analyzed all hospital data from roughly the last 30 years in the Netherlands. For each treatment, they charted scientific evidence of effectiveness that had been published and medical guidelines that had recommended that the treatment no longer be used. They compared this with how often doctors in Dutch hospitals still used the treatment.
Wasting scarce resources
The idea for this study came about in 2018 when an international group of researchers published in which treatments are ineffective or even harmful for back pain in the Lancet.
APH Researcher Pieter Coenen: "Our expectation was that these types of treatments had not taken place in the Netherlands for a long time, but this turns out not to be true. We still offer care in the Netherlands for a long time that is not evidence-based at all. If it has already been scientifically proven that a therapy does not work, it will take another 17 years or more before 85% of doctors abandon that treatment. We thus waste scarce resources and even do more harm than good with certain therapies for back pain. Take ’bed rest’, for example. We know this is counterproductive for back pain, yet it is still practiced."
Causes
The researchers think there are two possible causes why ineffective treatments remain in use for so long. Coenen: "It may have to do with how treatments are financed in our healthcare system. In doing so, we look too little at the result achieved by an intervention and pay per operation. That makes it more financially attractive to carry out many and complex treatments than for a patient to receive the best and most efficient care. This is something for policymakers to think about."
A second reason has to do with the slow pace at which new knowledge trickles down to the workplace. "It is often difficult for physicians to always stay up-to-date with the latest insights and apply this in practice. Through training and education, we should still try to quickly give way to treatments that are effective instead of treatments that have been scientifically proven not to work."
Read the article in The European Journal of Pain.