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Following on the seminal papers of 2018 The Lancet today publishes a call for action to improve treatment and eliminate waste associated with care for low back pain. Lancet low back pain.

The main messages are:

Low back pain is still the number one cause of disability in the world

Many patients with low back pain are still receiving the wrong care

Much of the money spent on low back pain care is wasted

Better policy solutions are needed and, to maintain the momentum of improvement, ten actions are recommended:

  1. Healthcare funders should stop paying for ineffective and harmful tests and treatments, and commission research on those that are unproven
  2. New tests and treatments should not be marketed, introduced into practice, or publicly reimbursed, before they have been adequately tested for safety, efficacy, cost-effectiveness
  3. Health and social services should work with employers to provide support that stimulates early return to work, and work conditions that are adapted to employee capacity
  4. Patients should be taught to self-manage low back pain and seek care only when really needed
  5. Widespread and inaccurate beliefs about low back pain in the population and among health professionals should be challenged, and the focus put on reducing the impact of low back pain on people’s lives rather than seeking medical treatment for a cure
  6. Clinical pathways, care plans, and other standardised tools managing low back pain should be redesigned to integrate health and occupational care but only after establishing their comparative effectiveness and cost-effectiveness
  7. Payment systems and legislation should be changed to encourage delivery of the right care
  8. The World Health Organisation should support new public policies and urgent political action to ensure strategies are put in place to reduce global disability from low back pain as a priority
  9. Research and funding bodies should invest in an intensified research effort to address gaps in the understanding of low back pain, as well as implementation research to determine how best to put existing knowledge and evidence to use
  10. Journals and the media should have greater editorial and peer-review oversight to ensure that trial results are accurately betrayed and do not reflect unwarranted belief in the efficacy of new or established but unproven therapies