Introduction Controversy exists regarding the value of lumbar plain x-ray imaging for patients with low back pain with or without radicular pain (1,2,3).

Methods Plain film x-ray and CT imaging from thirty (30; 19M:11F) consecutive patients (aged 20–68 years; mean 42 years) presenting to a public hospital’s spinal pain clinic with low back pain +/− radicular pain, without a history suggesting ‘red flag’ pathology, was examined and measured to determine the incidence of retrolisthesis of L5 on S1 and any associated disc bulge/protrusion.

Results Sixteen of the thirty patients (53%) had retrolisthesis of L5 on S1 ranging from 2–9 mm; these patients had either intervertebral disc bulging or protrusion on CT examination ranging from 3–7 mm into the spinal canal. Fourteen patients (47%) without retrolisthesis (control group) did not show any retrolisthesis and the CT did not show any bulge/protrusion. On categorizing x-ray and CT pathology as being present or not, the well positioned ie. true lateral plain x-ray film revealed a sensitivity and specificity of 100% ([95% Conf. Int. = [89%–100%]) for bulge/protrusion in this preliminary study. On taking into account the numerical values of x-ray and CT, a significant correlation (p< 0.001) was found.

Discussion In this preliminary study, carefully positioned lateral lumbosacral x-ray films showing L5 on S1 retrolisthesis are highly suggestive of intervertebral disc bulge/protrusion, providing valuable guidance for consideration of lumbosacral CT of MRI examination that is likely to be contributory regarding such pathology.

Introduction: Low back pain (LBP) is a common symptom in Australian adults. In any 6-month period approximately 10% of Australian adults suffer some significant disability from low back pain¹. One way of assessing the impact of LBP on a population is to estimate the economic costs associated with the disorder. This method is usually known as a “Cost-of-Illness” or an “Economic Burden” study². The economic burden of disease is often divided into direct and indirect costs and is most often calculated using the Human Capital Method². According to this method the direct costs are represented by the dollar value of the interventions required for diagnosis, treatment and rehabilitation of the disease and the indirect costs by valuing the loss of productivity due to morbidity and mortality^2,3. We estimated the economic burden of LBP in Australian adults.

Methods: Data sources used in this study were the 2001 Australian adult low back pain prevalence survey¹ and a multiplicity of Commonwealth, State and Private Health instrumentalities. Using the Human Capital Method direct costs were estimated on the basis of market prices (charges) and the indirect costs by valuing the loss of productivity due to morbidity. The conservative Friction Cost Method for calculating indirect costs was also used as a comparison⁴. A sensitivity analysis was undertaken where unit prices and volume for a range of services were varied over a feasible range (10%) to review the consequent change in overall costs.

Results: We estimated the direct cost of low back pain in 2001 to be AUD$1.02 Billion. Approximately 71% of this amount is for treatment by chiropractors, general practitioners, massage therapists, physiotherapists and acupuncture. However, the direct costs are minor compared to the indirect costs of AUD$8.15 Billion giving a total cost of AUD$9.17 Billion. The sensitivity analysis showed very little change in results.

Discussion: The economic burden of low back pain in Australian adults represents a massive health problem. This burden is so great that it has compelling and urgent ramifications for health policy, planning and research. This study identifies that research should concentrate on the reduction of indirect costs. This is not to suggest excluding direct cost research, as it is likely that early, efficient and evidence-based management of low back pain in the first instance may lessen the indirect costs that often follow. These startling results advocate urgent Government attention to LBP as a disorder.

Introduction: There is no shortage of treatments for low back pain (LBP), including medication, injections, bed rest, physiotherapy, chiropractic, osteopathy, acupuncture, massage therapy, and surgery. In addition to this are a plethora of home and folk remedies. However, there is still doubt about the efficacy or effectiveness of even the most common forms of therapy¹. Also, little is known about the proportion of persons who seek care for LBP, why they sought care, the type of care sought and indeed what differentiates them from those who do not seek care at all. The objective of this study was to determine the characteristics of Australian adults who seek care for LBP, including the type of care they choose and any factors associated with making those choices.

Methods: An age, gender and State stratified random sample of 2768 Australian adults was selected from the Electoral Roll. This sample were mailed a fully structured questionnaire that included a series of questions relating to care-seeking for LBP, choice of provider and types of treatment received. In addition a series of questions were asked relating to demographic characteristics, socioeconomic variables, and severity of LBP. Also asked was cigarette smoking status, anthropometric variables, perceived cause of low back pain, emotional distress, job satisfaction, physical fitness, past 5-year health status, and whether the subject feared LBP could impair their work capacity or life in the future.

Results: The survey response rate was 69.1%. The sample proved to be similar to the Australian adult population. The majority of respondents with LBP in the past 6-months did not seek care for it (55.5%). Factors that increased care seeking were higher grades of pain and disability, fear of the impact of pain on future work and life and female sex. Factors decreasing the likelihood for seeking care were identified as the cause of pain being an accident at home and also never being married. General medical practitioners and chiropractors are the most popular providers of care.

Discussion: High levels of pain and disability equating with higher levels of care-seeking would not surprise, however fear as a motivator for care-seeking has implications for clinical practice. Another important issue is the type of care selected for LBP. Using the best evidence available for the management of LBP is now seen as a responsibility for all practitioners. It would be useful to compare care-seeking with the evidence of the efficacy and effectiveness of the various therapies utilised.

INTRODUCTION: Low back pain (LBP) is a common symptom in Australian adults. In any six months period approximately 10% of Australian adults suffer some significant disability from low back pain¹. One way of assessing the impact of LBP on a population is to estimate the economic costs associated with the disorder. This method is usually known as a “Cost-of-Illness” or an “Economic Burden” study². The economic burden of disease is often divided into direct and indirect costs and is most often calculated using the Human Capital Method2. According to this method the direct costs are represented by the dollar value of the interventions required for diagnosis, treatment and rehabilitation of the disease and the indirect costs by valuing the loss of productivity due to morbidity and mortality^2,3. We estimated the economic burden of LBP in Australian adults.

METHODS: Data sources used in this study were the 2001 Australian adult low back pain prevalence survey¹ and a multiplicity of Commonwealth, State and Private Health instrumentalities. Using the Human Capital Method direct costs were estimated on the basis of market prices (charges) and the indirect costs by valuing the loss of productivity due to morbidity. The conservative Friction Cost Method for calculating indirect costs was also used as a comparison⁴. A sensitivity analysis was undertaken where unit prices and volume for a range of services were varied over a feasible range (10%) to review the consequent change in overall costs.

RESULTS: We estimated the direct cost of low back pain in 2001 to be AUD$1.02 Billion. Approximately 71% of this amount is for treatment by chiropractors, general practitioners, massage therapists, physiotherapists and acupuncture. However, the direct costs are minor compared to the indirect costs of AUD$8.15 Billion giving a total cost of AUD$9.17 Billion. The sensitivity analysis showed very little change in results.

DISCUSSION: The economic burden of low back pain in Australian adults represents a massive health problem. This burden is so great that it has compelling and urgent ramifications for health policy, planning and research. This study identifies that research should concentrate on the reduction of indirect costs. This is not to suggest excluding direct cost research, as it is likely that early, efficient and evidence-based management of low back pain in the first instance may lessen the indirect costs that often follow. These startling results advocate urgent Government attention to LBP as a disorder.

INTRODUCTION: There is no shortage of treatments for low back pain (LBP), including medication, injections, bed rest, physiotherapy, chiropractic, osteopathy, acupuncture, massage therapy, and surgery. In addition to this are a plethora of home and folk remedies. However, there is still doubt about the efficacy or effectiveness of even the most common forms of therapy¹. Also, little is known about the proportion of persons who seek care for LBP, why they sought care, the type of care sought and indeed what differentiates them from those who do not seek care at all. The objective of this study was to determine the characteristics of Australian adults who seek care for LBP, including the type of care they choose and any factors associated with making those choices.

METHODS: An age, gender and State stratified random sample of 2768 Australian adults was selected from the Electoral Roll. This sample were mailed a fully structured questionnaire that included a series of questions relating to care-seeking for LBP, choice of provider and types of treatment received. In addition a series of questions were asked relating to demographic characteristics, socioeconomic variables, and severity of LBP. Also asked was cigarette smoking status, anthropometric variables, perceived cause of low back pain, emotional distress, job satisfaction, physical fitness, past five year health status, and whether the subject feared LBP could impair their work capacity or life in the future.

RESULTS: The survey response rate was 69.1%. The sample proved to be similar to the Australian adult population. The majority of respondents with LBP in the past six months did not seek care for it (55.5%). Factors that increased care seeking were higher grades of pain and disability, fear of the impact of pain on future work and life and female sex. Factors decreasing the likelihood for seeking care were identified as the cause of pain being an accident at home and also never being married. General medical practitioners and chiropractors are the most popular providers of care.

DISCUSSION: High levels of pain and disability equating with higher levels of care-seeking would not surprise, however fear as a motivator for care-seeking has implications for clinical practice. Another important issue is the type of care selected for LBP. Using the best evidence available for the management of LBP is now seen as a responsibility for all practitioners. It would be useful to compare care-seeking with the evidence of the efficacy and effectiveness of the various therapies utilised.