[Back pain: do we follow the recommendations in the guidelines?]. / Lumbalgia: seguimos las recomendaciones de las guías?

OBJECTIVE: To describe how patients with back pain are usually handled at a health centre. DESIGN: Retrospective, descriptive study. SETTING: Urban health centre. PARTICIPANTS: All patients seen for back pain in the centre's general medical consultations during 2003. MAIN MEASUREMENTS: Patients' personal details, clinical characteristics of back pain (alarm signals), semiological data, request for further tests, treatments prescribed, referral to specialists. RESULTS: Five hundred and thirty eight clinical histories were included. 53.2% of patients were women, and 33.6% were over 55. 35% of patients were not questioned on pain characteristics; and in over half the cases (54.6%), there were no questions on the presence of alarm signals, either. Only in 0.6% of cases was any analogical visual scale used to assess pain. Only 46.8% of the x-rays taken were thought to be well indicated, in terms of pre-established criteria. Total rest was not normally advised (1.9%); the drugs most commonly prescribed were NSAIDs (39.6%). CONCLUSIONS: Clinical evaluation of patients with back pain is still inadequate in our centre, and x-rays are requested without adherence to formal or explicit criteria. We prescribe more NSAIDs than paracetamol for therapy.

Lumbalgia: ¿seguimos las recomendaciones de las guías? / Back pain: do we follow the recommendations in the guidelines?

Objetivo. Describir el tratamiento habitual de los pacientes con lumbalgia en un centro de salud. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Centro de salud urbano. Participantes. Todos los pacientes atendidos por lumbalgia en las consultas de medicina general del centro durante el año 2003. Mediciones principales. Datos de filiación de los pacientes, características clínicas de la lumbalgia (señales de alarma), datos semiológicos, solicitud de pruebas complementarias, tratamientos prescritos y derivación a especialistas. Resultados. Se incluyeron 538 historias clínicas. El 53,2% correspondía a mujeres y el 33,6% tenía más de 55 años. No se realizó interrogatorio sobre las características del dolor en un 35% de pacientes, y en más de la mitad de los casos (54,6%) tampoco se interrogó sobre la presencia de señales de alerta. Respecto a la evaluación del dolor, sólo en el 0,6% de los casos se había utilizado una escala visual analógica (EVA). Únicamente el 46,8% de las radiografías realizadas se consideró bien indicado según criterios preestablecidos. El reposo absoluto no se recomendó de forma habitual (1,9%) y los fármacos más prescritos (39,6%) fueron los antiinflamatorios no esteroideos (AINE). Conclusiones. La evaluación clínica de los pacientes con lumbalgia sigue siendo inadecuada en nuestro centro y la solicitud de estudios radiológicos se realiza sin tener en cuenta criterios formales y explícitos. En el apartado terapéutico, prescribimos más AINE que paracetamol

Objective. To describe how patients with back pain are usually handled at a health centre. Design. Retrospective, descriptive study. Setting. Urban health centre. Participants. All patients seen for back pain in the centre's general medical consultations during 2003. Main measurements. Patients' personal details, clinical characteristics of back pain (alarm signals), semiological data, request for further tests, treatments prescribed, referral to specialists. Results. Five hundred and thirty eight clinical histories were included. 53.2% of patients were women, and 33.6% were over 55. 35% of patients were not questioned on pain characteristics; and in over half the cases (54.6%), there were no questions on the presence of alarm signals, either. Only in 0.6% of cases was any analogical visual scale used to assess pain. Only 46.8% of the x-rays taken were thought to be well indicated, in terms of pre-established criteria. Total rest was not normally advised (1.9%); the drugs most commonly prescribed were NSAIDs (39.6%). Conclusions. Clinical evaluation of patients with back pain is still inadequate in our centre, and x-rays are requested without adherence to formal or explicit criteria. We prescribe more NSAIDs than paracetamol for therapy