Most back pain patients ‘do not require surgery’

OVER 90% of referrals of patients with chronic back pain referred to surgical clinics are a waste of time and could be treated by non-surgical means.

This is according to a survey looking at 100 consecutive GP referrals to an orthopaedic surgical outpatient clinic. Of that number, only six required surgery.

However, the large number of wasted unnecessary referrals caused long delays for those waiting to see consultants. Although priority cases could be seen within one month, others were left waiting up to six months for a consultation.

Many were forced to stay out of work during this period leading to economic hardship and continued physical discomfort.

The findings of the survey, which were published in Medicine Weekly, will be presented at a surgical symposium in Galway later this week. (Leave in reference to Medicine Weekly)

Irish College of General Practitioners chief executive Richard Brennan said the main problem for GPs continues to be a lack of access to proper diagnostic methods.

“It is easy to get a simple radiography done, but a GP cannot go any further with tests like CAT scans and such without a surgical referral,” he said.

Mr Brennan also pointed to the lack of properly developed primary care services as a factor in the large number of unnecessary referrals.

Access to community physiotherapy services is virtually non-existent in many parts of the country, forcing GPs to refer patients to clinics.

There is also a lack of rheumatologists in the country to deal with arthritic pain.

Traditionally, in the absence of proper rheumatic care, these patients would be referred to orthopaedic clinics.

Some GPs are also pressurised by patients who are suffering from chronic back pain into referring them to an orthopaedic consultant, according to Mr Brennan.

Orthopaedic surgeon Dr Kieran O’Rourke said more specialist GPs in the diagnosis and treatment of back pain were needed.

Dr O’Rourke told Medicine Weekly that ‘physiatrists’ based on European and American models should be introduced in the Irish health system to help remove some of the workload from overburdened orthopaedic surgeons.