The majority of patients suffering from lower back pain who are referred to the hospital’s outpatients’ clinic could instead be managed in the community, according to a study published in the Malta Medical Journal.

It shows that only 15 in 100 patients sent to the clinic by GPs required further investigations such as having an MRI scan.

The rest were discharged after having been referred for physiotherapy or to the pain clinic.

Entitled ‘Outcome of low back pain patients referred to orthopaedic outpatient clinic’, the aim of the study was to find out whether patients referred to Mater Dei Hospital’s outpatients’ clinic by their family doctor deserved such specialist consultation.

The study was carried out by Sarah Cuschieri, Stephan Grech and Joe Borg.

The patients included 55 males and 45 females between the ages of 11 and 82. Of these, 57 patients had been referred to outpatients for the first time while 43 had already been seen previously by an orthopaedic specialist.

Only 15 needed further investigations. The majority, 68, were discharged and referred for physiotherapy – something their doctor could have done.

The other 16 patients were discharged after having been referred to the pain clinic.

“General practitioners, unfortunately, lack the access to refer patients to the pain clinic,” the authors said.

They recommended that family doctors should be provided with local guidelines on when to refer patients to orthopaedic outpatients and when to manage low back pain complaints at primary healthcare level.

It would undoubtedly result in shorter waiting time for an orthopaedic outpatient visit

Doctors, they said, should start by prescribing pain relievers as the first line of therapy, unless symptoms suggest otherwise, and patients should be encouraged to remain active.

If this does not relieve the pain, then the doctor should refer patients directly to physiotherapy for a core-strengthening exercise programme.

“Only when these steps fail should referral to orthopaedic outpatients be considered, depending on the patient’s clinical evaluation.

“We believe that following this lower back pain management plan will lead to a better delivery of management of this common complaint.

“Patients would benefit from achieving timely targeted treatment with the added comfort of being managed in the community.

“It would undoubtedly result in shorter waiting time for an orthopaedic outpatient visit as well as result in more time and effort being spent on patients needing spinal surgery,” they concluded.