GPs who have a special interest in treating back pain are more likely to recommend tests and treatments that are ineffective or possibly even harmful.

That’s the surprising conclusion from a survey of more than 3800 GPs from NSW and Victoria who were asked for their views on the appropriate management of back pain.

About one-quarter of those with a special interest in back pain (versus 16 per cent of other GPs) thought patients should not return to work until they are almost pain free.

Eighteen per cent of special-interest GPs (versus nine per cent of others) thought patients should be prescribed complete bed rest until the pain disappeared.

These findings contrast with evidence-based recommendations for people to stay active and to continue with their ordinary activities as much as possible.

GPs with a special interest in back pain were also more likely to support the use of tests whose routine use is not recommended. Forty one per cent thought x-rays of the lumbar spine were useful, versus 29 per cent of other GPs.

“These findings raise serious concerns about how back pain is currently being managed among general practitioners with a special interest in lower back pain,” the researchers reported recently in the journal Spine.

One of the researchers, Professor Rachelle Buchbinder, a rheumatologist and clinical epidemiologist at Monash University, told Crikey that the findings were particularly concerning as doctors with a special interest in back pain report seeing almost twice as many people with back pain per week than those without a special interest.

“These findings are one reason why we are now calling for low back pain to become a National Health Priority Area,” she said. “This would recognise the profound burden of back pain on the health and well being of Australians and promote a coordinated national approach to addressing the problem. This would provide a more cohesive focus for demedicalising back pain and promoting best evidence-based care.”

The study’s findings are important — not only for the many back pain sufferers (with estimates that up to 80 per cent of adults will be affected at some stage) — but also because they raise broader issues about the forces driving health care.

Back pain is an example of how medicalisation of some health problems can be to patients’ detriment. Perhaps the study’s findings are not so surprising after all when you consider that an evidence-based approach to back pain reduces demand for medical consultations, tests and treatments.

There are few, if any, powerful lobbies with an interest in promoting active self-management by back pain sufferers, and in encouraging them to keep active, stay positive and keep away from surgeons if at all possible.

Interestingly, the survey was conducted in three waves (1997, 2000 and 2004) as part of efforts to evaluate just such a campaign, Back Pain: Don’t Take It Lying Down, mounted by the Victorian WorkCover Authority from 1997 to 1999.

The campaign, according to this report reflected the Authority’s concern that “although the traditional biomedical approach to back pain management was playing a role in the development of disability, and contributing to the escalating costs, targeting health care providers alone had limited impact upon changing clinical practice.”

One of the campaign’s main messages was that back pain sufferers can do a lot to help themselves, which emphasises shifting the responsibility of control onto the individual.

An evaluation showed the campaign was effective – it was the “first worldwide to show that mass media could successfully be used to reduce the overall burden of illness due to low back pain” — and it has since been copied in several places overseas.

So why haven’t we seen more such campaigns in Australia?

You’d think that health ministers — and treasurers — would be interested, given how much money is spent on unnecessary tests (one study found that low back pain is the most common reason for imaging requests in primary care).

It’s a question worth pondering as the health debate is again showing every sign of staying stuck on medical and hospital services rather than the population’s health.