Summary Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of low back ...pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific low back pain does not have a known pathoanatomical cause, treatment focuses on reducing pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review. The clinical course of low back pain is often favourable, thus many patients require little if any formal medical care. Two treatment strategies are currently used, a stepped approach beginning with more simple care that is progressed if the patient does not respond, and the use of simple risk prediction methods to individualise the amount and type of care provided. The overuse of imaging, opioids, and surgery remains a widespread problem.
Abstract Background In the original Global Burden of Disease (GBD) Study 1990, there was minimal involvement of clinical experts. By contrast, it was a key focus for GBD Study 2010 to explicitly ...engage a large and diverse group of experts. From the outset, the extent of the work involved from both the expert groups and the core team was a big unknown. Our aim is to reflect on the experiences of the Musculoskeletal Disorders and Risk Factors Expert Group (MSK EG), led by Professor Lyn March at University of Sydney, and to make constructive suggestions to the Core Team for future studies. Methods Synthesis of issues documented and discussed by MSK EG through the course of GBD 2010. Findings EG advice was critical for the accurate collection and interpretation of data. There were active problems throughout the process, notably in the following areas: (1) significant heterogeneity in the quality of epidemiological data available to be included in the systematic reviews; (2) timely interaction and due consultation by the Core Team with EGs relating to (a) ongoing changes to key aspects of the methodology and modelling and (b) finalisation and interpretation of results; and (3) project support for the EGs. Interpretation Our main suggestions are (1) to expand data collection, improve data quality, and strengthen methodology by (a) publication of guidelines for population-based studies to provide information in a more standardised format, and (b) forward engagement with end users of GBD and data collection agencies at a national level by the Core Team to facilitate the activities linked to gathering and collating the GBD data; (2) for EGs to continue to play an integral part of any future studies, and for the communication between the Core Team and EGs over data matters, methodology, and interpretation of results to be improved; and (3) to put in place, by the Core Team, a funding mechanism to provide adequate support to EGs throughout the course of the study. Funding Australian Commonwealth Government, the Institute of Bone and Joint Research (IBJR) at the University of Sydney, and the Bill & Melinda Gates Foundation.
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