Authored by Matiss Mezals*
Abstract
Low back pain is one of the leading causes of disability worldwide. Nevertheless, there is no consensus regarding recommendations for usage of lumbar supports for patients with low back pain which was demonstrated by asking opinions to different health care specialists. Thus, this confusion decreases trust in health care professionals and compliance of the patients for the treatment. Evidence is scarce and conflicting therefore making it difficult for medical experts to give firm recommendations. We do not have evidence-based answer to what type or material lumbar supports should be used. Nevertheless, manufactures claim that every kind of lumbar supports are safe and effective. In our opinion lumbar supports can be effective if used in conjunction with other treatment modalities especially exercise. Further studies are necessary to develop consensus among health care professionals and restore trust in the eyes of patients.
Keywords: Lumbar orthosis; Low back pain
Abbrevations:: LBP- Low Back Pain
Introduction
Low back pain is one of the leading causes of disability and work absenteeism worldwide [1]. It’s treated by various types of health care professionals starting from general physicians till surgeons. Therefore, it is crucial that patients receive correct, similar and evidence-based information from health care specialists. Unfortunately, too often we see patients who have received contradictory information from various health care specialists which results in low patient compliance and reduced trust in health care system in general. In our daily practice we see that there is a relative consensus regarding pharmacological treatment of LBP among health care professionals, but there are vast differences in approach to patients with LBP in non-pharmacological treatment. One of the most contradictory topics lately have been usage of lumbar supports for LBP patients therefore we would like to state our opinion and urge for further research and discussion.
Discussion
We asked opinion about lumbar support to the leading health care professionals in Latvia, who most commonly encounter patients with low back pain: general practitioners, neurologists and physiatrists. Views about usage of lumbar support for LBP varied vastly among them ranging from denial of utility of such supports till possible usage of the most part of the day. Deciding whether to use lumbar supports as treatment option, general practitioners based their opinion on patients’ profession and amount of physical activity in the work. However, physiatrists and neurologists tended to consider the diagnosis as primary criteria. This can easily confuse the patient as there are vast variations in recommendations from different specialists. Confusion continues also among medical experts because some research of LBP treatment state that it is possible to use lumbar supports for LBP prevention [2,3] and some state that it is not proven to be effective to use lumbar support for patients with LBP [5,6] and some guidelines even do not mention lumbar supports as a treatment option [7]. In either case strong evidence is lacking to support or reject usage of lumbar supports. In addition, guidelines do not specify type (soft\semi rigid\rigid) and material of lumbar support which is recommended and suits best. Also, it is not clear for how long period lumbar supports should be used. Other important questions that arise are whether lumbar supports decrease work absenteeism and increase participation and quality of life. As for the most treatments we need to take into consideration possible side effects which seem to be few [8], but still psychological dependence to lumbar supports can develop. Nevertheless, the most manufactures claim that lumbar supports treat back pain of various causes without enough evidence [9]. All these questions need to be investigated in order to reach consensus. Although we do not have strong evidence, based on our daily experience we recommend lumbar supports for short time period during the day if patients feel pain relief or stability in addition to other treatment methods especially exercise. We do not recommend using them alone.
Conclusion
Opinions about usage of lumbar supports for LBP are contradictory between health care professionals. Furthermore, research about lumbar supports are scare and evidence for recommendations are not strong enough. Further studies are needed to confirm or reject usage of lumber supports for low back pain hence health care professionals can reach consensus and improve quality of care for their patients.
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