Article Title: Family Physician and Specialist Knowledge of Low Back Pain Management Studies Reviewed: 1. Buchbinder R, Staples M, Jolley D. Doctors with a special interest in back pain have poorer knowledge about how to treat back pain. Spine 2009; 34(11): 1218-1226. 2. Orthopaedists’ and family practitioners’ knowledge of simple low back pain management. Spine 2009; 34(15): 1600-1603. BACKGROUND INFORMATION It is well known that low back pain (LBP) is a common and costly condition. LBP pa- tients often fi rst consult with their family physician (and then perhaps a specialist) in hopes of fi nding answers regarding their pain and appropriate treatment suggestions. In fact, back pain is the most common musculoskeletal reason for consulting a family doctor. It is therefore imperative that GPs have a high competence in managing these patients. This year, one of the most highly regarded spinal medicine journals published two studies which, taken together, suggest that those who are consulted fi rst (in most cases) for LBP are not managing this condition in an evidence-based manner. This includes family physicians, orthopedic surgeons, and even those doctors with a reported “spe- cial interest” in back pain. To borrow a line from the Canadian Chiropractic Protective Association’s Dr. Greg Dunn…OUCH!! As chiropractors, we hold a special level of knowledge about back pain, and possess Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. numerous treatment tools that can be useful in its management. Currently, significant effort is being put forth to position us as the “spinal care experts” in the Canadian health- care system. With such a “title” comes great responsibility. While reading the results of these two studies, readers should ask themselves how our profession would fare in a similar study… CONCLUSIONS AND PRACTICAL APPLICATION: The two studies paint a disappointing picture of medical management of simple LBP. The integration of some major evidence-based concepts (such as not prescribing bed rest, the limited utility of imaging, and the broad spectrum use of COX-2 NSAIDs) is severely lacking. Further, it is particularly alarming that orthopedist knowledge surrounding simple LBP is defi cient, especially when one considers the major risks and poor prognosis as- sociated with their primary intervention (surgery). Taken together, these results should provide a strong wake-up call for medical practitioners and educators. Rather than pointing a shameful fi nger at our medical colleagues, chiropractors should seize this opportunity to review and update their own knowledge on evidence- based management of LBP so we can continue to provide top-notch care to our patients, and improve our growing reputation among medical practitioners and patients as the spinal care experts. • For full review including Study Description and Results, please visit www.canadianchiro- practor.ca. This brief review is a sample of the content posted weekly on Research Review Service and is one of over 60 reviews available per year of the latest scientific literature in chiropractic. RRS is approved for 4.0 CEUs/year by CMCC. 46 • CANADIAN CHIROPRACTOR | SEPTEMBER 2009 www.canadianchiropractor.ca Shawn Thistle, BKin (Hons), DC, CSCS
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